1° 


c ^ 


SPECIAL  NOTE. 

Mr.  John  Barrett,  the  Director  of  the  Inter- 
national Bureau  of  the  American  Republics,  an 
institution  devoted  to  the  development  of  comity 
and  commerce  among  the  American  nations,  and 
which  acts  incidentally  as  the  office  of  the  Inter- 
national Sanitary  Bureau,  presents  his  compli- 
ments to  the  readers  of  this  volume,  and,  in 
expressing  the  hope  that  they  will  enjoy  a  perusal 
of  its  contents,  desires  to  state  that  if  they  care 
for  further  information  concerning  the  Latin- 
American  Republics  they  can  obtain  it  by  ad- 
dressing him  at  the  International  Bureau  offices, 
Washington,  D.  C. 


TRANSACTIONS  OF  THE  THIRD  INTERNA- 
TIONAL SANITARY  CONFERENCE  OF  THE 
AMERICAN  REPUBLICS 

a.-JTV^ 


HELD  AT  THE  NATIONAL 
PALACE,  CITY  OF  MEXICO, 
DECEMBER  2-3-4-5-6-7,  1907 


PUBLISHED  AND  DISTRIBUTED  UNDER  THE  AUSPICES  OF  THE 

INTERNATIONAL  BUREAU  OF  THE  AMERICAN  REPUBLICS 

WASHINGTON,  D.  C. 

1909 


PRESS  OF  BYRON  S.  ADAMS, 
WASHINGTON,  D.  C. 

MEPMOOUCCO    BY 

THE    COLUMBIA    PUtNOONAPH    CO., 
WASHINGTON.     0.    C. 


BANCROFT  LIBRARY 

U 
lAPR  23  1940 


INDEX. 


PAGE. 

Officers  of  the  Convention 5 

Officers  of  the  International  Sanitary  Bureau  of  Washington 6 

Convocation  of  the  Third  International  Sanitary  Convention 7 

Program  of  the   Third   International   Sanitary   Convention   of  American 

Republics 11 

Death  of  Senor  Licenciado  Don  Jose  Algara 14 

Transactions  of  the  Third  International  Sanitary  Convention  of  American 

Republics : 
First  day,  Monday,  December  2,  1907 — 

Morning — Opening  session  15 

Afternoon  session   27 

Second  day,  Tuesday,  December  3 — 

Morning  session  33 

Third  day,  Wednesday,  December  4 — 

Morning  session    40 

Afternoon  session   51 

Fourth  day,  Thursday,  December  5 — 

Night  session    57 

Fifth  day,  Friday,  December  6 — 

Morning  session    • 72 

Night  session    81 

Sixth  day,  Saturday,  December  7 — 

Morning  session  86 

Afternoon  session   97 

Appendix : 

Feasts  and  social  functions  in  honor  of  the  Delegates 115 

Letter  from  the  Convention  to  the  President  of  the  Mexican  Republic.  117 
Tribute  of  respect  to  the  Chairman  of  the  Convention,  Dr.  Eduardo 

Liceaga  118 

Adherence  of  the  Brazilian,  Colombian  and  Uruguayan  Delegates  to  the 

Convention  of  Washington  of  1905 1 19 

Subjects  that  will  form  part  of  the  Fourth  International  Sanitary  Con- 
vention   120 

Resolutions  adopted  by  the  First,  Second  and  Third  International  Sani- 
tary Conventions   121 

Reports  presented  by  the  Delegates  to  the  Convention : 

Brazil 137 

Chile 139 

Colombia 158 

Costa  Rica 160 

Cuba 162 

Ecuador 169 

Guatemala 171 

Honduras 173 

Mexico 173 

Salvador 188 

United  States 194 

Uruguay 219 


CALL  FOR  THE  FOURTH  INTERNATIONAL  SANITARY 

CONVENTION. 

In  accordance  with  the  resolution  adopted  at  the  Third  International 
Sanitary  Convention,  held  in  the  City  of  Mexico,  December  2-7,  1907, 
the  date  December  25,  1909,  to  January  2,  1910,  has  been  fixed  for  the 
assembling  of  the  Fourth  International  Sanitary  Convention  in  the 
city  of  San  Jose,  Costa  Rica. 

The  following  official  correspondence  in  regard  to  the  call  and  the 
provisional  program  of  the  convention  are  printed  in  the  interest  of 
the  Convention. 

INTERNATIONAL   SANITARY  BUREAU, 

WASHINGTON,  U.  S.  A. 

June  12,  1909. 
HON.  JOHN  BARRETT, 

Director,  Bureau  American  Republics, 

Washington,  D.  C. 
SIR: 

In  accordance  with  the  resolution  adopted  at  the  Second  International  Sani- 
tary Convention  of  American  Republics  authorizing  biennial  conventions,  and 
in  accordance  with  the  action  taken  at  the  last  convention  in  Mexico  City,  De- 
cember, 1907,  I  enclose  herewith  a  call  for  the  Fourth  International  Sanitary 
Convention  of  the  American  Republics  to  meet  in  Costa  Rica  December  25,  1909, 
to  January  2,  1910. 

In  accordance  with  paragraph  7  of  the  resolutions  relating  to  international 
sanitary  police,  adopted  at  the  Second  International  Conference  of  American 
States  in  Mexico,  January  29,  1902,  I  have  to  request  that  you  take  such  measures 
as  you  deem  advisable  to  make  announcement  of  this  call. 

It  is  also  requested  that  the  Bureau  of  American  Republics  in  making  this 
announcement  also  make  representations  to  the  government  of  Costa  Rica  in 
order  that  there  shall  be  issued  through  its  Department  of  Foreign  Relations 
invitations  to  the  several  countries  to  be  represented. 

Respectfully, 

WALTER  WYMAN, 
Chairman,  International  Sanitary  Bureau. 

FOURTH  INTERNATIONAL  SANITARY  CONVENTION  OF  THE 
AMERICAN  REPUBLICS, 

To  BE  HELD  IN  SAN  Jos£,  COSTA  RICA,  DECEMBER'S,  1909,  TO  JANUARY  2,  1910. 

INTERNATIONAL  SANITARY  BUREAU  OF  THE  AMERICAN  REPUBLICS, 

WASHINGTON,  D.  C.,  June  14,  1909. 

In  accordance  with  the  resolution  adopted  by  the  Second  International 
Sanitary  Convention  of  the  American  Republics,  which  authorizes  biennial 
conventions,  and  in  accordance  with  the  action  taken  at  the  Third  International 
Sanitary  Convention,  it  is  hereby  announced  that  the  Fourth  International 


Sanitary  Convention  of  the  American  Republics  will  be  held  in  San  Jose, 
Costa  Rica,  December  25,  1909,  to  January  2,  1910. 

It  is  respectfully  urged  that  every  Republic  of  the  Western  Hemisphere  be 
represented  at  this  convention,  both  those  that  have  been  heretofore  represented 
and  those  which  have  not  taken  part  in  the  previous  conventions. 

In  accordance  with  resolutions  adopted  at  previous  conventions,  there  will 
be  considered  practical  means  for  the  adoption  of  measures  intended  to  obtain 
the  sanitation  of  cities  and  especially  of  ports.  This  subject  has,  therefore,  been 
included  in  the  provisional  program,  which  has  been  prepared  by  the  President- 
elect of  the  coming  convention  with  the  view  to  continuing  the  work  of  previous 
conventions. 


PROVISIONAL  PROGRAM  FOR  THE  INTERNATIONAL  SANITARY  CONVEN- 
TION OF  THE  AMERICAN  REPUBLICS  TO  BE  HELD  IN  SAN  JOSE, 
COSTA  RICA,  DECEMBER  25,  1909,  TO  JANUARY  2,  1910. 

1.  Reports  presented  by  the  different  delegates  in  regard  to  the  sanitary 
regulations  and  laws  adopted,  and  in  force,  in  their  respective  tountries,  since 
tKfe  last  meeting. 

2.  Special  report  by  each  official  delegate  regarding  the  manner  in  which 
the  resolutions  adopted  in  the  three  previous  conventions  have  been  put  into 
practice,  in  their  respective  countries. 

3.  Reports  in  regard  to   sanitary  conditions  in  ports,  and  measures  pro- 
posed for  the  improvement  of.  such  sanitary  conditions   (with  special  reference 
to  the  principal  ports). 

4.  Reports  relating  to  the  registration  of  the  movement  of  population  and 
the  rate  of  mortality  in  each  country,  specifying  those  of  ports  and  principal 
cities. 

5.  Sanitation  of  cities  and  especially  of  ports. 

6.  Measures  for  the  protection  of  passengers  that  embark  in  vessels  from 
infected  ports. 

7.  Discussion  of  measures  against  the  introduction  of  diseases  not  included 
in  the  Convention  of  Washington  of  1905. 

8.  Sanitary  models  or  forms  to  be  adopted  by  Nations  forming  part  of  this 
Convention. 

9.  Discussion    on    sanitary    measures    relating   to    Yellow    Fever,    Bubonic 
Plague,  Tuberculosis,  Malaria,  and  other  diseases,  in  conformity  to  new  dis- 
coveries, or  experiences. 

10.  Discussion  on  measures  relating  to  venereal  diseases. 

11.  Discussion  on  the  necessity  of  the  adoption,  by  the  European  Nations, 
of  the   Convention   of  Washington   and  other   sanitary  measures   subsequently 
adopted   by   this   Convention   with   respect   to   such   colonies   as   they   have    in 
America. 

12.  Discussion   on    new    discoveries    with    respect   to   the   transmission   of 
yellow  fever  and  malaria,  besides  the  mosquito  bite. 

13.  Organization   in    each    country    represented   at    this    Convention,   of   a 
commission  of  three  physicians  or  health  officers  to  act  as   delegates  of  the 
International   Sanitary   Bureaus  of  Washington   or   Montevideo,   and   to   form 
part   of   the    International    Sanitary   Information   Committee   of   the   American 
Republics. 

By  direction  of  the  International  Sanitary  Bureau  of  the  American  Republics. 

WALTER  WYMAN, 

Chairman. 
JUAN  J.  ULLOA, 

Secretary. 


As  requested  in  the  communication  of  Dr.  Walter  Wyman,  Chair- 
man of  the  International  Sanitary  Bureau,  the  Director  of  the  Inter- 
national Bureau  of  the  American  Republics  has  addressed  a  letter 
to  the  diplomatic  representatives  of  the  countries  interested  in  the 
Convention  transmitting  a  copy  of  the  Call,  and  the  Provisional 
Program,  which  has  also  been  given  to  the  press,  and  will  be  printed 
in  the  Bulletin  of  the  Bureau. 


MEMBERS  OF  THE  INTERNATIONAL  SANITARY  BUREAU  OF  WASHINGTON. 


DR.  A.  H.  DOTY. 
United  Statei. 


DR.  JUAN  GUITERAI, 
Cuba. 


DM.  JUAN  J.  ULLOA, 
Costa  Rica, 
Secretary. 

DR.  WALTER  WYMAN, 
United  Statei, 

Preiidrnt. 

DR.  EDUARDO  LICKACA. 
Mexico. 


DR.  EDUARDO  MOORE 
Chile. 


DK.  RHCTT  GOODE, 
United  Stalei. 


OFFICERS  OF  THE  CONVENTION. 

President. 

Doctor  EDUARDO  LICEAGA,  President  of  the  Supreme  Board  of  Health  of  Mexico. 

Vice-Presidents. 

Surgeon-General  WALTER  WYMAN,  United  States  Public  Health  and 

Marine-Hospital  Service. 
Doctor  OSWALDO  GONQALVEZ  CRUZ,  Brazil. 
Doctor  RICARDO  GUTIERREZ  LEE,  Colombia. 
Doctor  JUAN  J.  ULLOA,  Costa  Rica. 
Doctor  JUAN  GUITERAS,  Cuba. 
Doctor  E.    SOZA,  Chile. 
Doctor  J.  H.  ESTEVES,  Ecuador. 
Doctor  SALVADOR  ORTEGA,  Guatemala. 
Doctor  Luis  LAZO  ARRIAGA,  Honduras. 
Doctor  GREGORIO  MENDIZABAL,  Nicaragua. 
Doctor  RODOLFO  B.  GONZALEZ.  Salvador. 
Doctor  ERNESTO  FERNANDEZ  ESPIRO,  Uruguay. 

Permanent  Secretary. 
Doctor  JUAN  J.  ULLOA,  Costa  Rica. 

Committee  on  Credentials. 

Senor  Licenciado  Don  JOSE  ALGARA,  Mexico. 
Doctor  RHETT  GOODE,  United  States. 
Doctor  SALVADOR  ORTEGA,  Guatemala. 

Advisory  Council. 

Doctor  EDUARDO  LICEAGA,  Mexico. 
Doctor  WALTER  WYMAN,  United  States. 
Doctor  JUAN  J.  ULLOA,  Costa  Rica. 
Doctor  E.  SOZA,  Chile. 
Doctor  R.  GUTIERREZ  LEE,  Colombia. 

Committee  on  Yellow  Fever. 

Doctor  JUAN  GUITERAS,  Cuba. 
Doctor  R.  H.  VON  EZDORF,  United  States. 
Doctor  O.  GoNgALVEZ  CRUZ,  Brazil. 
Doctor  W.  G.  OWEN,  United  States. 

Committee  on  Bubonic  Plague. 

Doctor  P.  LAUTARO  FERRER,  Chile. 
Doctor  E.  LICEAGA,  Mexico. 
Doctor  P.  T.  STRAUB,  United  States. 

Committee  on  Trachoma  and  Spinal-Cerebral  Meningitis. 

Doctor  JAMES  GATEWOOD,  United  States. 
Doctor  G.  MENDIZABAL.  Nicaragua. 
Doctor  H.  ROBERTS.  Cuba. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

Committee  on  Tuberculosis. 

Doctor  H.  L.  E.  JOHNSON,  United  States. 
Doctor  J.  AZURDIA,  Guatemala. 
Doctor  L.  LAZO  ARRIAGA,  Honduras. 

Committee  on  Malaria. 

Doctor  G.  PAYAN,  Colombia. 
Doctor  R.  B.  GONZALEZ,  Salvador. 
Doctor  J.  H.  ESTEVES,  Ecuador. 


International  Sanitary  Bureau  of  the  American  Republics, 
Washington,  D,  C. 

Chairman. 
Surgeon-General  WALTER  WYMAN,  United  States. 

Secretary. 
Doctor  JUAN  J.  ULLOA,  Costa  Rica. 

Members. 

Doctor  EDUARDO  LICEAGA,  Mexico. 
Doctor  EDUARDO  MOORE,  Chile. 
Doctor  A.  H.  DOTY,  United  States.      . 
Doctor  JUAN  GUITERAS,  Cuba. 
Doctor  RHETT  GOODE,  United  States. 


CONVOCATION  OF  THE  THIRD  INTERNATIONAL  SANI- 
TARY CONVENTION. 

In  accordance  with  the  resolution  adopted  at  the  Second  International  Sani- 
tary Convention  held  in  the  City  of  Washington,  October  9-14,  1905,  the  date 
of  December  2-7,  1907,  has  been  fixed  for  the  assembling  of  the  Third  Inter- 
national Sanitary  Convention  in  the  City  of  Mexico. 

The  Convention  is  held  under  authority  of  resolutions  of  the  Second  Inter- 
national Conference  of  the  American  States  held  in  the  City  of  Mexico  in 
1901-2,  and  of  the  Third  International  Conference  of  American  States  held  in 
the  City  of  Rio  de  Janeiro  in  1906. 

The  following  official  correspondence  in  regard  to  the  call  is  herewith  pro- 
mulgated : 

INTERNATIONAL  SANITARY  BUREAU, 

WASHINGTON,  U.  S.  A.,  June  18,  1007. 
"MR.  JOHN  BARRETT, 

"Director,  Bureau  American  Republics, 

"Washington,  D.  C. 

"SiR:  In  accordance  with  a  resolution  adopted  at  the  Second  International 
Sanitary  Convention  of  American  Republics,  October,  1905,  I  enclose  herewith 
a  call  for  the  Third  International  Sanitary  Convention  of  the  American  Repub- 
lics to  meet  in  the  City  of  Mexico,  December  2-7,  1907. 

"In  accordance  with  paragraph  7  of  the  resolutions  relating  to  international 
sanitary  police,  adopted  at  the  Second  International  Conference  of  American 
States  in  Mexico,  January  29,  1902,  I  have  to  request  that  you  will  take  such 
measures  as  you  deem  advisable  to  make  announcement  of  this  call. 

"It  is  also  requested  that  the  Bureau  of  American  Republics  request  the 
Department  of  State  to  invite  the  attention  of  envoys  at  this  Capital,  whose 
countries  have  not  as  yet  ratified  the  Sanitary  Convention  ad  referendum  of 
Washington,  to  the  desirability  of  doing  so.  and  urge  them  to  secure  repre- 
sentation at  the  coming  Convention  in  Mexico  City. 

"Respectfully, 

"WALTER  WYMAN, 
"Chairman,  International  Sanitary  Bureau." 

"THIRD   INTERNATIONAL   SANITARY   CONVENTION   OF  THE  AMERICAN   REPUBLICS, 
"To  be  held  in  the  City  of  Mexico,  December  2-7,  1907. 

"INTERNATIONAL   SANITARY    BUREAU 

OF  THE  AMERICAN  REPUBLICS, 
"WASHINGTON,  D.  C.,  June  17,  1007. 

"In  accordance  with  a  resolution  adopted  by  the  Second  International  San- 
itary Convention  of  the  American  Republics,  it  is  hereby  announced  that  the 
Third  International  Sanitary  Convention  will  be  held  in  the  City  of  Mexico, 
December  2-7,  1907. 

"It  is  respectfully  urged  that  every  Republic  of  the  Western  Hemisphere  be 
represented  at  this  Convention  both  those  that  have  been  heretofore  represented 
and  those  which  have  not  taken  part  in  the  previous  conventions. 

"It  will  be  remembered  that  the  First  Convention,  held  in  Washington  from 
the  2d  to  the  5th  of  December,  1902,  was  called  in  compliance  with  the  5th 
of  the  resolutions  relative  to  Sanitary  Police  adopted  by  the  Second  International 
Conference  of  American  States  in  Mexico.  January  29.  1902.  These  resolutions 
were  accepted  as  the  basis  for  the  work  of  the  First  Convention,  which  was  of 
a  character  chiefly  scientific,  and  resulted  in  the  adoption  of  certain  sanitary 
and  hygienic  principles  and  the  establishment  of  an  International  Sanitary 
Bureau  at  Washington. 

"The  Second  International  Sanitary  Convention  which  was  held  in  Wash- 
ington from  the  9th  to  the  I4th  of  October,  1905,  assumed  a  more  formal  char- 
acter than  the  previous  one,  and  resulted  in  the  subscription  to  a  "Sanitary 
Convention  ad  referendum,"  concluded  on  October  14,  1905,  which  codified  all 
the  measures  destined  to  guard  the  public  health  against  the  invasion  and 


8  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

propagation  of  yellow  fever,  plague  and  cholera.  This  Sanitary  Convention  ad 
referendum  has  been  ratified  by  at  least  nine  republics,  and  attention  is  respect- 
fully invited  to  the  following  paragraph  contained  therein : 

"  The  governments  which  may  not  have  signed  the  present  Convention  are 
to  be  admitted  to  adherence  thereto  upon  demand;  notice  of  this  adherence 
to  be  given  through  diplomatic  channels  to  the  Government  of  the  United  States 
of  America,  and  by  the  latter  to  the  other  signatory  governments.' 

"As  will  be  seen  below,  the  Conference  at  Rio  de  Janeiro  in  August,  1006, 
recommended  the  adoption  of  the  same  Convention  by  all  the  countries  therein 
represented. 

"Resolutions  adopted  at  Rio  de  Janeiro,  August,  1906. 

"Following  are  the  resolutions  of  the  Third  International  Conference  of 
American  States  at  Rio  de  Janeiro  in  August,  1906,  indicating,  among  other 
measures,  matters  for  consideration  by  the  Sanitary  Convention  to  be  held  in 
Mexico  City. 

The  Third  American  International  Conference  recognizes  the  desirability 
of  the  Principles  of  International  Sanitary  Police  which  inspired  the  last  Con- 
ference held  in  Rio  de  Janeiro,  as  applicable  to  a  specific  region,  and  the  con- 
vention which  was  signed  in  Washington  on  the  I4th  of  October,  1905,  which 
is  applicable  to  all  sections  of  America,  and  therefore  makes  the  following 
recommendations  to  the  countries  here  represented: 

"i.  That  as  a  general  rule,  they  should  adopt  said  International  Convention 
of  Washington,  adhering  to  the  same  and  putting  its  precepts  into  practice. 

"2.  The  adoption  of  measures  intended  to  obtain  the  sanitation  of  the  cities 
and  especially  of  the  ports,  as  well  as  to  obtain,  as  far  as  possible,  a  better 
knowledge  and  a  better  observance  of  hygienic  and  sanitary  principles. 

"3.  The  desirability  of  having  all  American  countries  represented  in  the 
coming  International  Sanitary  Conference  which  is  to  be  held  in  the  City  of 
Mexico  in  December,  1907,  and  that  the  respective  delegates  to  that  Conference 
should  be  instructed  to  study  and  resolve  the  following  points: 

"(a)  Practical  means  for  giving  effect  to  the  Second  of  the  present  recom- 
mendations. 

"(fc)  The  establishment  and  regulation  in  each  of  the  American  countries 
of  a  commission  co.mposed  of  three  public  medical  or  sanitary  officers,  in  order 
that,  under  the  direction  of  the  International  Sanitary  Office,  established  in 
Washington,  they  may  constitute  an  International  Bureau  of  Sanitary  Informa- 
tion throughout  the  American  Republics,  with  power  to  collect  and  com- 
municate all  data  relating  to  public  health  and  such  others  as  the  Conference 
may  consider  desirable. 

"(c)  The  establishment  and  organization  in  the  place  in  South  America  which 
the  Conference  may  designate,  of  a  Bureau  of  Sanitary  Information  which 
will  furnish  to  the  International  Sanitary  Bureau,  already  existing,  the  necessary 
data  to  comply  with  recommendations  V.  VI  and  VII,  relative  to  sanitary 
police,  which  were  adopted  by  the  Second  American  International  Conference. 

"(rf)  The  establishment  of  relations  between  the  International  Sanitary 
Bureau,  now  existing  in  Washington,  and  the  'Bureau  Sanitaire  International,' 
of  Paris,  in  order  to  obtain  the  best  information  on  sanitary  subjects  and  to 
reach  agreements  that  will  facilitate  the  objects  with  which  both  offices  are 
established. 

"4.  In  accordance  with  the  provisions  of  paragraph  c,  article  3,  the  City  of 
Montevideo  is  designated  as  the  residence  of  the  Bureau  of  Sanitary  Infor- 
mation." 

"Provisional  Program  for  the  International  Sanitary  Convention  in  Mexico  City, 

December  2-7,   1007. 

"The  following  program  has  been  arranged  to  embody  the  sanitary  principles 
considered  by  the  previous  conventions  and  in  conformity  with  the  resolutions 
adopted  by  the  Conference  at  Rio  de  Janeiro: 

"ist.  Each  delegate  will  bring  a  paper  relating  to  the  nation  he  represents. 
This  paper  will  cover  the  following  points: 

"(o)  A  report  on  the  existence  of  transmissible  diseases  which  may  prevail 
in  its  territory,  especially  with  reference  to  bubonic  plague,  yellow  fever,  cholera. 


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THIRD    INTERNATIONAL    SANITARY    CONVENTION.  9 

malaria,  beri-beri  and  trachoma.  This  report  will  give  detailed  information  on 
the  measures  which  have  been  adopted  for  the  prevention  of  stamping  out 
of  any  of  the  diseases  above  mentioned,  if  they  are  unfortunately  present  in 
the  country  represented  by  the  delegate. 

(&)  A  report  on  the  condition  of  the  ports  of  his  country,  specifying  the 
works  which  may  have  been  executed  therein,  those  in  course  of  construction 
and  those  which  are  projected,  as  well  as  the  manner  in  which  the  problem  of 
water  supply,  of  proper  sewerage  and  of  the  connection  of  house  drains  with 
that  system  of  sewers  has  been  resolved,  as  well  as  the  methods  that  have  been 
employed  or  are  proposed  for  the  sanitation  of  the  dwellings. 

(<r)  A  return  of  the  assistance  which  the  general  governments  may  have 
furnished  to  the  respective  states  or  municipalities,  for  the  execution  of  sanitation 
works  in  the  cities  and  ports. 

"(rf)  A  report  on  all  the  sanitary  police  laws  which  have  been  issued  since 
the  I4th  of  October,  1905. 

"2d.  Every  delegate  will  suggest  some  practical  means-  to  prevent  persons 
who  may  be  suffering  from  tuberculosis  from  transmitting  the  disease  to  the 
healthy  persons  who  may  be  traveling  in  their  company,  either  in  trains  or  in 
vessels. 

"3d.  As  forming  part  of  the  order  of  the  day,  the  delegates  will  be  at 
liberty  to  present  original  papers  relating  to  the  following  points: 

"(a)   Studies  directed  to  the  discovery  of  the  germ  of  yellow  fever; 

"(&)  Studies  directed  to  the  investigation  as  to  whether  there  are  other  means 
of  transmission  of  yellow  fever  and  malaria  besides  the  sting  of  the  mosquitoes, 
and 

"(O  Studies  directed  to  the  perfection  of  the  methods  of  combating  the 
mosquito. 

"4th.  Each  delegate  will  present  a  report  upon  the  organization  in  his  own 
country  of  the  commission  of  three  medical  or  sanitary  officers  intended  to  form 
part  of  the  International  Sanitary  Commission  of  Information  of  the  Ameri- 
can Republics,  as  provided  for  in  paragraph  3  (&)  of  the  Resolutions  adopted 
at  Rio  de  Janeiro. 

"5th.  Report  upon  the  establishment  of  the  Sanitary  Information  Bureau 
of  Montevideo  as  provided  in  paragraph  3  (c)  and  paragraph  4  of  the  Resolu- 
tions adopted  at  Rio  de  Janeiro. 

^  "6th.  Report  upon  the  establishment  of  relations  between  the  International 
Sanitary  Bureau  at  Washington  and  the  Bureau  Sanitaire  International  of  Paris, 
as  provided  in  paragraph  3  (d)  of  the  Resolutions  adopted  at  Rio  de  Janeiro. 

"7th.  Besides  the  full  papers  and  reports  above  mentioned,  each  delegate 
will  bring  an  extract  of  the  same,  but  so  concise  that  it  can  be  read  in  fifteen 
minutes.  These  extracts  alone  will  be  read  during  the  meetings. 

"8th.  All  the  extracts  will  be  written  in  Spanish  and  English.  Those  pre- 
sented by  the  delegates  from  Brazil  will  be  in  Portuguese  and  English,  and 
those  by  the  delegates  from  Haiti  will  be  in  French  and  English,  so  that  while 
each  delegate  reads  his  extract  in  his  own  language,  the  others  can  follow  read- 
ing the  same  document  in  the  language  with  which  they  are  familiar. 

'By  direction  of  the  International  Sanitary  Bureau  of  the  American  Republics. 

"WALTER  WYMAN, 
"Chairman." 

As  requested  in  the  letter  of  June  18,  1907,  addressed  by  Dr.  Wyman,  the 
Chairman  of  the  International  Sanitary  Bureau,  to  Mr.  John  Barrett,  Director 
of  the  Bureau  of  American  Republics,  Mr.  Barrett  addressed  to  the  diplomatic 
representatives  of  each  of  the  States  composing  the  International  Union  of  the 
American  Republics  a  communication  in  which  he  says: 

"I  have  the  honor  to  enclose  copies,  respectively,  of  a  letter  addressed  to  me 
as  Director  of  the  International  Bureau  of  the  American  Republics  by  Dr.  Walter 
Wyman,  Chairman  of  the  International  Sanitary  Bureau,  and  of  a  call,  signed  by 
Dr.  Wyman,  for  the  Third  International  Sanitary  Convention  of  the  American 
Republics,  to  be  held  in  the  City  of  Mexico,  December  2-7,  1907,  and  to  request 
that  you  will  be  good  enough  to  forward  this  call  to  your  Government,  and 
make  such  recommendations  as  you  deem  fit  for  its  worthy  representation  at 
this  Convention. 

"I  may  add,  as  a  result  of  a  conference  with  Chairman  Wyman,  that  every 
effort  is  being  made  by  the  Mexican  Government  to  ensure  the  success  of  this 
gathering,  and  it  is  hoped,  in  view  of  the  importance  of  the  work  before  it, 
that  each  American  Republic  may  decide  to  appoint  delegates," 


Program  of  the 
Third  International  Sanitary  Convention  of  American  Republics. 


MEXICO    CITY,    DECEMBER    2   TO   7,    IQO7. 


MONDAY,    THE    2D 
MORNING. 

10  o'clock.  Inaugural  Session  in  the  special  hall  of  the  Department  of  the 
Treasury  (National  Palace). 

Speech  by  the  Vice-President  of  the  Republic  and   Secretary  of  the 

Interior. 

Speech  by  the  President  of  the  Convention. 
Reply  by  one  of  the  delegates  in  the  name  of  all  the  Republics  that 

accepted  the  invitation,  or  brief  reply  by  each  delegate. 
Appointment  of  committees. 

AFTERNOON. 

From  3  to  6.     Session  in  the  special  hall  of  the  Department  of  the  Treasury. 
Reading  of  the  reports  presented  by  each  delegate  in  the  name  of  his 
country  and   in   regard  to   the  different   subjects   referred  to   the 
Provisional  Program  of  the  Convention. 
The  reading  shall  be  made  by  roll  call  of  the  Republics. 

NIGHT. 

8  o'clock.  Banquet  given  in  honor  of  the  Delegates  to  the  Convention  by  the 
Supreme  Council  of  the  .Federal  District  Government  and  the  Municipality 
of  Mexico,  Municipal  Palace. 

TUESDAY,    THE    3D. 
MORNING. 

8  o'clock.  Visit  to  the  Penitentiary  of  Mexico.  The  train  that  will  take  the 
party  to  the  Penitentiary  will  start  from  the  Plaza  de  la  Constitucion  (oppo- 
site the  National  Palace)  at  8.00  a.  m. 

From  10  to  12.  Session  in  the  special  hall  of-  the  Department  of  the  Treasury. 
Continuation  of  the  reading  of  the  reports. 

12  o'clock.    Visit  to  the  Post  Office  building. 

AFTERNOON. 

3.30  o'clock.  The  President  of  the  Republic  will  receive  the  Delegates  at  the 
National  Palace. 

After  the  reception  a  visit  will  be  made  to  the  Palace  of  Chapultepec. 

WEDNESDAY,  THE  4TH. 
MORNING. 

From  9  to  12.    Session  in  the  place  indicated. 

Discussion  of  the  measures  of  international  sanitary  police  against  yellow 
fever  proposed  in  the  reports  or  on  motion  of  the  Delegates. 


12  THIRD   INTERNATIONAL    SANITARY    CONVENTION. 

AFTERNOON. 

From  3  to  4.    Session  in  the  place  indicated. 

Discussion  on  malaria,  on  the  subject  of  the  same  reports  or  motions. 

4  o'clock.    Visit  to  the  Supreme  Board  of  Health  and  the  Disinfection  plants. 
From  5  to  6.30.    Session  in  the  place  indicated. 

Discussion  on  measures  of  international  sanitary  police  against  bubonic 
plague  and  cholera  proposed  in  the  reports  or  on  motion  of  the 
Delegates. 

NIGHT. 

5  o'clock.    Concert  in  the  Arbeu  Theatre,  in  honor  of  the  Delegates. 

THURSDAY,  THE  5TH. 
MORNING. 

o'clock.  Excursion  to  Xochimilco  and  the  Water  Works  of  Mexico  City. 
The  trains  for  this  excursion  will  start  from  the  Plaza  de  la  Constitucion 
(opposite  National  Palace)  at  8.30  a.  m.  Visit  to  the  Water  Works.  In 
Chapultepec  there  will  be  a  transfer,  to  the  trains  that  will  convey  the  Dele- 
gates to  the  Water  Works. 
Lunch  at  Xochimilco. 

Returning  there  will  be  a  transfer  at  San  Antonio  and  the  electric  cars 
wjll  take  the  delegates  to  the  National  Palace  where  a  session  will 
be  held  from  6  to  8  p.  m. 

NIGHT. 

From  6  to  8.    Session  in  the  place  indicated. 

Discussion  on  measures  against  trachoma,  beri-beri  and  other  trans- 
missible diseases. 

FRIDAY,  THE  6TH. 
MORNING. 

From  9  to  12.    Session  in  the  place  indicated. 

Discussion  on  measures  for  the  prevention  of  tuberculosis  on  board 
ships  and  railroad  cars. 

AFTERNOON. 

3  o'clock.    Visit  to  the  Juarez,  Roma  and  La  Condesa  colonies  of  Mexico  City. 
Visit  to  the  General  Hospital,  the  Pumping  Station,  the  sewer-cleaning 
plant,  and  a  national  primary  school. 

NIGHT. 

From  7  to  9.     Session  in  the  place  indicated. 

Continuation  of  the  discussion  on  amendments  to  the  previous  con- 
vention. 

Reading  of  reports  on  the  discovery  of  the  yellow  fever  germ;  on 
other  means  of  transmission  of  yellow  fever  and  malaria,  besides 
the  mosquito  bite,  and  on  studies  tending  to  improve  the  methods 
of  exterminating  the  mosquito. 

SATURDAY,   THE   7TH. 
MORNING. 


From  8  to  12.    Session  in  the  place  indicated. 
Discussion  of  pending  subjects. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  I£ 

Adoption  of  resolution  presented  in  the  previous  session. 

Presentation  by  each  delegate  of  a  report  on  the  organization  in  his 
country  of  a  commission  composed  of  three  physicians  or  health 
officers,  to  form  part  of  the  International  Sanitary  Information 
Committee  of  the  American  Republics. 

AFTERNOON. 

From  3  to  5.    Closing  session  in  the  place  indicated. 

Designation  of  the  place  for  the  next  Conference. 

Designation  ^of  the  authority  who  will  issue  the  invitations  for  the  next 
Convention. 

Appointment  of  the  President  for  the  next  Convention. 

Appointment  of  the  President  and  personnel  of  the  International  Sani- 
tary Bureau  of  the  American  Republics. 

Brief  farewell .  address  fry  each  delegate,  and  reply  by  the  President 
of  the  Convention. 

NIGHT. 

8  o'clock.    Dinner  given  by  the  Mexican  Delegation  in  honor  of  the  Delegates 
of  the  other  Republics. 


DEATH  OF  SENOR  LICENCIADO  DON  JOS£ 
ALGARA. 

It  is  with  profound  sorrow  that  we  announce  the  death 
of  Senor  Don  Jose  Algara,  Assistant  Secretary  of  Foreign 
Relations  of  Mexico  and  one  of  the  Delegates  of  the  Mexi- 
can Government  to  the  Third  International  Sanitary  Con- 
ference of  American  Republics,  which  occurred  on  the  10th 
of  March,  ultimo.  Senor  Algara  was  one  of  the  most 
prominent  officials  of  the  Mexican  Republic,  where  he  held 
very  important  positions,  filling  them  with  the  ability  due  to 
his  personality,  talents  and  learning. 

The  repeated  acts  of  kindness  and  courtesy  that  he  ex- 
tended to  the  Members  of  the  Convention,  as  an  official  of 
the  Government,  as  a  friend  and  as  a  private  person,  won 
for  him  the  gratitude  and  friendship  of  the  delegates,  and 
thus  the  pain  that  they  feel  on  account  of  his  untimely  death 
is  still  deeper. 

The  undersigned  feels  that  he  is  faithfully  interpreting 
the  sentiments  of  all  the  members  of  the  Third  Inter- 
national Sanitary  Convention  of  American  Republics 
when  he  offers  collectively,  to  the  Government  of  Mexico 
and  to  the  family  of  Senor  Algara,  the  protests  of  oui 
sincerest  condolence  for  the  irreparable  loss  they  have 
suffered. 

New  York,  March  15,  1908. 

(Signed)  JUAN  J.  ULLOA, 
Permanent  Secretary. 


THE  LATE  MR.  JOSE  ALGARA, 

Undersecretary  of  Foreign  Relations  of  the  Republic  of  Mexico,  and  a  Mem- 
ber of  the  Mexican  Delegation  to  the  Third  Sanitary  Conference  of  the 
American  Republics,  held  in  Mexico  City  in  December,  1907.  He  died 
March  10,  1908. 


THIRD  INTERNATIONAL  SANITARY  CON- 
VENTION OF  AMERICAN  REPUBLICS. 


FIRST  DAY— MONDAY,  DECEMBER  2. 
Morning — Opening  Session. 

The  Convention  was  called  to  order  at  10  A.  M.  by  Sefior  Don 
Ramon  Corral,  Vice-President  of  the  Republic  of  Mexico.  Eleven 
Republics  were  represented  at  this  opening  session  by  the  following 
Delegates:  Dr.  Oswaldo  Goncalvez  Cruz,  Brazil;  Drs.  Ernesto  Soza 
and  Pedro  Lautaro  Ferrer,  Chile;  Drs.  Ricardo  Gutierrez  Lee  and 
Genaro  Payan,  Colombia;  Dr.  Juan  J.  Ulloa,  Permanent  Secretary  of 
the  Convention,  Costa  Rica;  Drs.  Juan  Guiteras  and  Hugo  Roberts, 
Cuba ;  Dr.  Juan  Horacio  Esteves,  Ecuador ;  Drs.  Salvador  Ortega  and 
Juan  Azurdia,  Guatemala;  Dr.  Luis  Lazo  Arriaga,  Honduras;  Dr. 
Eduardo  Liceaga,  Chairman  of  the  Convention,  Senor  Licenciado  Don 
Jose  Algara,  and  Engineer  Hilario  Elguero,  Mexico;  Dr.  Gregorio 
Mendizabal,  Nicaragua;  Dr.  Rodolfo  B.  Gonzalez,  Salvador,  and  Drs. 
Walter  Wyman,  J.  Gatewood,  P.  J.  Straub,  H.  L.  E.  Johnson,  Rhett 
Goode,  and  R.  H.  von  Ezdorf,  United  States.  The  Vice-President  of 
the  Republic  welcomed  the  Delegates  as  follows : 

"Honorable  Delegates : 

"The  most  important  of  the  resolutions  adopted  by  the  Second  In- 
ternational Conference  of  American  Republics,  held  in  this  city  in 
1901-2,  was  perhaps  the  one  providing  for  the  meeting  of  periodical 
sanitary  conventions  for  the  purpose  of  studying  and  adopting  meas- 
ures of  prevention  in  the  countries  of  this  Hemisphere  against  the 
propagation  of  infectious  diseases  through  littorals  and  frontiers,  and 
for  the  encouragement  of  sanitation  in  each  country.  And  I  consider 
that  resolution  of  the  illustrious  Assembly  referred  to  as  one  of  the 
most  transcendental,  because,  besides  the  excellence  of  its  purpose,  it 
has  the  quality  of  being  entirely  practical. 

"A  result  of  that  resolution  have  been  the  two  Sanitary  Conventions 
held  in  Washington  in  December,  1902,  and  October,  1905,  and  the 
one  whose  opening  assembles  us  here  today.  Among  other  positive 
benefits  that  have  been  obtained,  the  Convention  signed  on  the  I4th  of 
October,  1905,  in  the  city  of  Washington  is  worthy  of  special  mention. 
That  convention  specifies,  not  only  the  measures  of  defense  that  coun- 
tries should  adopt  against  infectious  diseases  appearing  in  other  na- 
tions, but  also  encourages  the  Governments  to  enforce  all  reasonable 
measures  for  the  purpose  of  quenching  the  propagation  of  epidemics 
that  constitute  a  real  scourge  to  the  people.  Based  on  the  Convention 
of  Paris  of  1903,  adopted  by  most  of  the  European  countries,  and  by 
some  of  America,  Asia,  and  Africa,  that  of  Washington  offers  all 


l6  THIRD   INTERNATIONAL   SANITARY    CONVENTION. 

the  guaranties  of  righteousness,  not  only  because  of  the  knowledge  of 
the  authors  of  that  of  Paris,  but  also  for  the  reason  that  the  Delegates 
to  the  Washington  Conference  supplemented  it  and  perfected  it  in 
accordance  with  the  last  conquest  of  science.  Of  the  eleven  Republics 
that  signed  it,  seven  have  ratified  it,  and  two  of  the  Central  American 
countries  that  were  represented  thereto  have  adhered  to  it.  These  coun- 
tries are  beginning  to  enjoy  the  benefits  derived  from  the  enforcement 
of  a  sanitary  legislation  wisely  codified,  and  which  is  profoundly  scien- 
tifical,  for  the  protection  against  certain  infectious  diseases  by  means 
of  uniform  and  reasonable  measures  which  enable  them  to  do  away 
with  all  customs  that,  based  on  the  fear  of  the  outbreak  of  an  epidemic, 
caused  considerable  damages. 

"As  in  everything  that  tends  to  eradicate  deep-rooted  prejudices  and 
errors  that  have  been  transmitted  from  generation  to  generation,  the 
new  sanitary  systems,  in  spite  of  being  founded  upon  the  serious  and 
profound  study  of  men  and  things,  encounter  with  difficulties  before 
becoming  general,  and  such  result  is  not  accomplished  but  with  the 
slowness  that  is  necessary  to  overcome  the  obstacles  that  old  ideas 
offer;  but  at  last  they  are  beginning  to  be  universal,  as  all  that  has 
truth  for  basis.  For  that  reason  it  is  to  be  hoped  that  this  Honorable 
assembly,  composed  of  learned  men  from  nearly  all  the  countries  of 
the  continent,  and  which  throws  new  light  on  the  work  that  has  been 
accomplished,  will  take  one  more  step  towards  the  end  Sought,  rectify 
errors,  from  which  no  human  work  is  free,  widen,  if  possible,  the 
conquests  that  have  been  gained,  and  succeed  in  obtaining  the  ad- 
herence of  not  only  the  nations  represented  in  this  Convention  and 
that  of  1905,  but  of  all  the  countries  of  America,  in  order  to  make 
uniform  upon  scientific  basis  the  sanitary  measures  which  have  for 
object  the  protection  of  human  life. 

"If  in  all  the  activities  of  life  countries  and  men  evolve  continuously, 
seeking  always  their  welfare,  and  if  the  principal  aim  of  progress  is  to 
render  human  existence  more  comfortable,  worthier,  and  more  pro- 
longed, it  is  obvious  that  the  questions  relating  to  public  health  are 
very  important  and  must  occupy  a  prominent  place  in  the  policy  of 
every  Government,  inasmuch  as  nothing  tends  more  to  the  accomplish- 
ment of  those  ends  than  the  measures  of  public  hygiene,  a  proof  of 
civilization  and  of  the  improvement  of  mankind. 

"These  facts  are  so  elementary  that  they  are  within  the  reach  of  all 
persons  that  have  some  education,  however"  incipient.  The  more  edu- 
cated the  citizens  of  a  nation  are,  the  greater  is  their  persistence  in 
requiring  from  the  public  administration  the  enforcement  of  sanitary 
measures  of  a  general  character,  and  the  Governments,  as  civilization 
becomes  more  and  more^  diffused,  pays  more  and  more  attention  to 
this  science,  propagating  its  principles  by  means  of  the  schools,  in  what 
regards  private  hygiene,  and  carrying  out  costly  improvements  and 
establishing  proper  institutions  to  meet  the  requirements  of  public 
health.  For  that  reason,  we  see,  that  conventions  meet  in.  the  more 
advanced  cities  of  Europe  and  America  for  the  purpose  of  encouraging 
interest  in  the  science  of  hygiene,  propagating  its  principles,  and  apply- 
ing the  latter  in  a  practical  way  to  the  life  of  countries;  also  for  the 
same  reason,  new  sanitation  works  are  projected  or  carried  put,  and 
new  discoveries  and  applications  are  made  in  the  war  against  disease. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  17 

"Our  country  complies  with  its  obligations  so  far  as  it  can.  Besides 
having  completed  the  gigantic  and  lasting  drainage  of  the  Valley  of 
Mexico  which  consumed  the  resources  and  energies  of  many  genera- 
tions, it  ha?  accomplished  the  sanitation  of  Mexico  City  as  has  been  or 
is  being  done  in  the  principal  ports,  Veracruz  and  Tampico  on  the 
Gulf  of  Mexico,  Puerto  Mexico  and  Salina  Cruz,  the  termini  of  the 
Interoceanic  Tehuantepec  railroad,  Mazatlan  and  Manzanillo  on  the 
Pacific,  and  those  of  the  most  important  cities,  Puebla,  Guadalajara, 
Chihuahua,  Monterrey,  Saltillo,  Torreon,  Durango,  Guanajuato,  Leon, 
Celaya,  San  Luis  Potosi,  Queretaro,  Toluca,  Cordoba,  Tacubaya  and 
Guadalupe  Hidalgo,  without  mentioning  towns  of  lesser  importance. 
There  are  also  many  cities  which  study  and  effect  their  sanitation. 

"For  the  realization  of  many  of  these  works  the  federal  government 
has  co-operated  by  expending  vast  sums  of  money,  thus  complying  with 
the  recommendation  of  the  second  international  conference  of  America 
and  the  states  and  municipalities  have  expended  and  are  expending 
many  millions  of  dollars  in  these  improvements. 

"For  many  years  Mexico  has  had  a  Superior  Board  of  Health  which 
has  worked  a  positive  interest  in  and  great  development  of  sanitary 
services,  creating  at  its  ports  and  frontiers  delegations  having  in 
charge  an  international  sanitary  police,  establishing  prophylactic  sys- 
tems of  vigilance  and  disinfection  and  fighting  successfully  epidemics 
which  have  appeared  in  the  country.  In  this  connection  it  is  worthy 
of  note  the  campaign  which  has  been  waged  by  this  body  against  the 
yellow  fever  scourge  which  for  centuries  has  sown  death  along  the 
coast  of  the  Gulf  of  Mexico,  a  campaign  in  which  it  will  soon  achieve 
a  splendid  victory. 

"I  speak  of  these  conquests  in  such  transcendental  matters  in  my 
country,  gentlemen,  not  only  as  a  just  motive  for  national  satisfaction 
but  also  because  your  program  comprises  topics  on  the  advancement 
and  development  in  the  public  health  service  within  your  countries 
and  to  give  you  a  pledge  that  the  Mexican  Republic,  comprehending 
the  high  ends  which  attend  this  work,  will  comply  with  loyalty  and 
with  determination  the  obligations  which  it  contracts  with  the  other 
countries  in  the  realization  of  the  proposals  which  come  within  your 
province. 

"The  program  of  your  labors  inspires  the  liveliest  interest.  You 
will  inform  each  other  mutually  of  the  labors  which  each  of  the  nations 
of  America  has  accomplished  or  is  preparing  to  accomplish  in  the 
interest  of  public  health;  you  will  communicate  the  results  of  your 
studies  on  a  matter  of  such  high  importance  as  the  transmission  of 
tuberculosis,  as  the  investigation  of  the  fever  germ  and  the  means 
of  the  transmission  of  this  peril  across  the  American  seas,  and  of 
malaria,  and  you  will  in  the  name  of  your  governments,  agree  on 
means  to  harmonize  the  action  of  American  Republics  in  the  matter 
of  sanitary  police,  fix  a  more  solid  basis  for  mutual  knowledge  for- 
tunately now  existing,  between  the  peoples  of  the  Western  Hemisphere 
and  to  prepare  for  the  future  unions  at  which  you  will  congregate. 

"I  can  entertain  no  doubt  of  your  success.  That  is  guaranteed  by 
your  wisdom  and  by  your  good  will. 

"Honorable  Delegates :— -In  the  name  of  the  President  of  the  Re- 
publ;c  I  welcome  you  to  Mexico,  which  receives  you  with  affection  and 


l8  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

friendship.     May  your  stay  in  it  be  as  agreeable  as  it  is  to  us  to  offer 
you  our  hospitality." 

Then  Dr.  Liceaga,  President  of  the  Convention,  delivered  the  fol- 
lowing speech : 

Mr.  Vice-President ;  Mr.  Minister ;  Honorable  Delegates : 

The  Mexican  Republic  feels  gratified  at  the  fact  that  her  capital  has 
been  chosen  as  the  seat  for  the  Third  International  Sanitary  Convention 
of  American  Republics;  this  capital,  where  six  years  ago  the  Second 
Conference  of  the  same  Republics  met,  which  adopted  the  first  resolu- 
tions on  International  Sanitary  Policy.  It  is  a  pleasure  for  our  country 
to  see  that  those  resolutions  have  been  accepted,  not  only  by  the  repre- 
sentatives of  the  Republics  that  signed  them,  but  also  by  the  nations 
themselves,  because  most  of  them  have  sent  delegates  to  the  two  Sani- 
tary Conventions  that  met  in  Washington  and  the  one  that  is  now 
inaugurated,  in  accordance  with  Section  V  of  said  Resolutions  of 
January  29,  1902. 

It  pleases  me  to  remind  you  that  the  first  Convention  resembled  a 
congress  of  hygienists,  that  had,  however,  the  merit  of  determining 
the  questions  from  a  technical  point  of  view;  of  taking  its  oath  of  faith 
before  the  scientific  world,  and  of  showing  in  a  practical  way  the 
interest  that  the  American  Republics  take  in  matters  of  hygiene,  which 
have  been  neglected  for  a  long  time,  as  if  health  were  not  the  most 
precious,,  gift  of  mankind.  The  second  Convention  arrived  at  the 
practical  solution  that  was  possible  to  reach  within  the  very  short 
period  of  six  days — that  of  making  an  agreement  for  the  protection 
against  three  of  the  diseases  that  most  cruelly  flagellate  humanity, 
to-wit:  Bubonic  plague,  cholera,  and  yellow  fever.  That  agreement 
has  been  a  decided  progress,  because  it  unites  under  the  same  interna- 
tional law  Republics  of  this  Continent  that  live  in  continuous  and 
necessary  communication. 

The  work  of  this  Convention  must  be,  first,  to  secure  the  adherence 
of  the  Republics  that  have  not  yet  given  full  consent  to  the  Convention 
of  Washington  of  1905.  The  securing  of  the  unanimous  vote  of  the 
Western  Hemisphere  in  behalf  of  the  Convention  of  Washington, 
should  not  be  considered  as  a  puerile  vanity — not  because  it  is  a  perfect 
work,  as  such  perfection  can  only  be  accomplished  with  time — but  on 
account  of  the  benefits  that  all  the  Nations  of  this  Hemisphere  will 
obtain  from  the  regulation  of  their  sanitary  matters  under  one  common 
sanitary  law.  Although  the  civilized  world  accepts  now  the  principles 
conquered  by  hygiene,  if  these  principles  are  not  expressed  in  the 
same  manner  in  the  legislation  of  each  country  that  is  going  to  form 
this  Convention,  the  construction  given  to  each  principle  will  neces- 
sarily give  origin  to  confusion  of  ideas  and  improper  application  of 
the  accepted  rules. 

It  has  always  been  said  that  if  the  peoples  of  the  world  spoke  the 
same  language,  used  the  same  system  of  weights  and  measures,  and 
had  a  common  legislation  in  all  matters,  they  would  understand  each 
other  better  and  further  their  interests  in  an  easier  way.  Now  then, 
as  the  accomplishment  of  that  end  is  not  possible,  let  us  seek  that 
uniformity  and  harmony,  at  least  in  the  legislation  regarding  interna- 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  IQ 

tional  sanitary  policy.  The  Convention  that  we  signed  at  Washington 
in  1905  establishes  a  community  of  purposes,  not  only  among  the 
nine  Republics  that  have  accepted  it  so  far,  but  also  among  the  sixteen 
European  nations,  besides  Persia  and  Egypt,  that  signed  the  Inter- 
national Convention  of  Paris  of  1903,  as  this  latter  one  and  that  of 
Washington  are  almost  identical.  This  means  that  twenty-seven  coun- 
tries of  Europe,  America,  Asia,  and  Africa,  regulate  at  present  their 
maritime  or  land  communications  in  accordance  with  a  uniform  law 
of  international  sanitary  policy. 

If  we  could  extend  this  benefit  to  the  other  twelve  nations  of  America 
which  have  not  yet  accepted  that  Convention,  we  would  show  that 
even  though  civilized  countries  may  be  separated  by  other  interests, 
they  are  united,  at  least,  in  matters  concerning  the  preservation  of 
health  and  the  prolongation  of  life. 

Our  first  resolution  should  be,  therefore,  to  secure  the  unanimous 
consent  of  the  Republics  of  the  Western  Hemisphere  to  accept  the 
Convention  of  Washington. 

If  we  reach  that  unanimous  agreement,  it  would  be  necessary  to 
fix  the  time  during  which  that  Convention  should  bind  the  nations 
signing  it;  it  would  not  be  wise  to  make  that  period  too  long,  because 
scientific  progress  and  experience  in  the  faithful  execution  of  the  laws 
in  force  would  show  its  deficiencies  or  require  the  adoption  of  new 
scientific  discoveries,  and  in  some  way  or  other  the  Convention  should 
be  modified  from  time  to  time. 

But  even  if  the  Convention  of  Washington  were  unanimously  adopted 
by  the  American  Nations,  it  would  only  protect  us  against  bubonic 
plague,  cholera,  and  yellow  fever. 

It  is  true,  Honorable  Delegates,  that  these  three  diseases  have  rav- 
aged entire  regions  and  ruined  commerce,  bringing  death  and  desolation 
to  inhabitants  of  the  invaded  countries ;  but  there  are  other  evils  that, 
without  causing  as  much  panic,  produce  greater  damage.  There  is, 
for  instance,  tuberculosis,  which  has  settled  itself  in  all  civilized  coun- 
tries, and  upon  which  the  valuable  attention  of  hygienists  should  be 
concentrated,  as  well  as  that  of  those  here  assembled,  in  order  to  point 
out  what  measures  should  be  adopted  for  the  prevention  of  this  dreadful 
foe  of  mankind.  The  fight  against  tuberculosis  has  been  undertaken 
everywhere  from  different  points  of  view ;  we  should  study  the  disease 
from  this  standpoint:  Its  transmission  in  those  vehicles  which  now 
make  communication  so  easy  and  rapid,  to-wit:  The  ships  and  the 
railroads.  This  important  question  deserves  your  greatest  attention, 
and  I  have  reasons  to  hope  that  you  will  give  it  due  consideration 
in  the  name  of  the  dearest  interests'  of  humanity. 

There  are  other  diseases  the  remedies  for  which  are  not  unknown, 
but  which  do  not  cause  the  beneficial  alarm  produced  by  the  others  that 
we  have  just  mentioned;  for  instance,  malaria  (which  prevails  in  so 
many  regions,  specially  in  those  of  the  littorals  of  both  oceans,  situated 
between  the  Tropics  of  Cancer  and  Capricorn),  not  only  causes  the 
death  of  many  persons  and  in  terrifying  numbers,  but  also  undermines 
slowly  the  constitution  of  others,  impoverishes  their  blood,  weakening  it 
gradually,  and,  therefore,  renders  them  invalid  for  work,  shortens 
extraordinarily  the  duration  of  their  lives,  and  is  a  powerful  factor  in 
the  degeneration  of  the  human  race.  The  means  to  protect  ourselves 


2O  THIRD   INTERNATIONAL    SANITARY    CONVENTION. 

against  this  disease  are,  as  I  have  said,  known  to  us,  but  no  effort  has 
been  done  to  propagate  them.  Upon  you,  Honorable  Delegates, 
depends  the  divulgation  of  the  knowledge  of  the  weapons  that  science 
has  placed  at  our  disposal,  enforcing  preventive  measures  among 
the  working  classes,  in  the  small  towns,  and  in  the  cities  where  the 
anopheles  mosquito  prevails,  undermining  the  most  robust  constitu- 
tions. 

Another  disease  of  slow  development,  which  had  been  confined,  so 
to  say,  to  the  Oriental  countries,  and  which,  according  to  statistics, 
causes  the  suffering  of  thirty  million  persons  on  the  surface  of  the 
earth,  tends  to  propagate  itself  rapidly  by  means  of  the  extreme  facility 
which  the  steam  provides  to  communication  by  land  or  sea;  I  refer  to 
trachoma,  heretofore  unknown  or,  rather,  known  only  to  oculists,  a 
disease  which  is  now  invading  our  countries  through  the  enormous  cur- 
rents of  immigration  from  the  Asiatic  states,  and  which  threatens  to 
become  as  generalized  an  evil  as  the  ones  mentioned  before.  It  is 
indispensable  that  the  Governments  should  see  to  it  that  the  introduc-. 
tion  of  a  disease  that  is  almost  unknown  in  their  countries  be  pre- 
vented. It  is  your  duty,  gentlemen,  to  prescribe  the  precise  rules 
which  should  serve  as  a  guide  to  legislators,  so  that  the  sanitary  codes 
of  all  nations  may  contain  definite  provisions  preventing  the  propaga- 
tion of  so  dreadful  a  scourge  of  humanity. 

It  is  strange  that  until  the  present  moment  legislators  have  only 
paid  attention  to  the  transmission  of  acute  diseases,  those  of  rapid 
incubation,  which  men  can  carry  from  one  town  into  another,  and  to 
which,  it  may  be  said,  international  sanitary  policy  has  been  confined 
so  far. 

It  is,  therefore,  indispensable  that  international  sanitary  policy  be 
provided  with  laws  preventing  the  introduction  into  countries  where 
they  had  been  unknown  until  the  present,  of  such  chronic  diseases  as 
trachoma,  beri-beri,  and  other  similar  ones. 

Honorable  Delegates :  For  many  centuries  the  peoples  of  the  earth 
have  paid  attention  only  to  their  defense  against  exotic  diseases,  without 
taking  into  consideration  that  it  would  be  much  more  sensible  and 
logical  to  prevent  any  disease  from  originating  in  their  respective 
country,  for  without  such  origin  no  disease  could  be  exported.  During 
the  last  sixty  years,  England  has  been  teaching  us  the  lesson  that  an 
exotic  disease,  whatever  it  be,  can  not  take  or  develop  in  healthy  cities ; 
cities  provided  with  a  water  supply  that  is  sufficient  in  proportion  to 
"(heir  population;  where  the  inevitable  human  and  animal  refuse  is 
transported  from  the  interior  of  dwellings  to  the  outskirts  of  the  town, 
in  which  it  can  not  be  noxious  to  health  but,  instead,  contribute  to 
fertilization  of  the  soil;  cities  the  streets  and  squares  of  which  are 
closely  and  impermeably  paved  and  frequently  sprinkled  and  swept, 
thus  avoiding  the  dust  that  propagates  the  different  and  multiple  dis- 
eases; cities  whose  dwellings  receive  the  amount  of  light  and  air  that 
is  indispensable  to  life,  thus  avoiding  human  conglomeration;  such 
cities  will  never  be  invaded  by  transmissible  diseases.  We  should 
imitate,  the  example  that  England  gives  us  constantly,  not  only  for 
the  purpose  of  preventing  the  exportation  of  diseases  to  other  coun- 
tries, but  also  in  order  to  protect  ourselves  against  them. 

The  best  proof  that  we  can  give  of  the  desirability  of  improving  our 


THIRD   INTERNATIONAL   SANITARY    CONVENTION.  21 

methods  is  found  in  what  is  now  taking  place  as  regards  yellow  fever 
in  the  Mexican  Republic.  The  legendary  and  fatal  focus  of  the  dis- 
ease which  during  four  centuries  has  existed  on  our  gulf  coast,  made 
us  the  terror  of  our  neighbors  and  even  of  distant  nations.  We  under- 
took a  campaign  against  yellow  fever  and  within  the  very  short  period 
of  three  months  we  extinguished  the  epidemic  that  like  a  trail  of 
gunpowder  extended  over  the  States  of  Tamaulipas,  San  Luis  Potosi, 
Nuevo  Leon  and  Coahuila,  as  far  as  our  northern  frontier  on  the  one 
side,  and  on  the  other  to  the  northern  shores  of  the  peninsula  of 
Yucatan.  That  epidemic  having  been  extinguished,  we  decided  to 
suppress  the  isolated  foci  that  had  remained  scattered  throughout  the 
states  of  Tamaulipas,  Veracruz  and  Yucatan,  where  this  terrible 
scourge  always  prevailed.  In  order  to  make  this  fight  effective,  we 
established  sanitary  brigades  in  Merida,  Progreso,  Veracruz,  Tampico, 
Coatzacoalcos,  Santa  Lucrecia,  Tehuantepec,  Salina  Cruz,  Cordoba 
and  Tierra  Blanca,  and,  after  a  vigorous  campaign  tenaciously  carried 
out,  not  only  during  the  period  when  the  dreaded  disease  reappears, 
but  also  throughout  all  seasons  of  the  year,  we  were  enabled  to  suppress 
all  the  foci  of  the  epidemic  and  deal  with  isolated  cases,  so  that  during 
the  eleven  months  which  have  elapsed  of  the  present  year,  after  an 
incessant  struggle  that  has  been  sustained  for  four  years,  we  have 
only  observed  five  cases  of  yellow  fever,  and  these  were  isolated  cases 
in  places  distant  from  each  other.  As  we  continue  fighting  the  dis- 
ease with  the  same  energy  as  if  a  real  epidemic  existed,  we  have  well 
founded  hopes  that  the  fearful  scourge  of  yellow  fever  will  disappear 
from  our  territory,  never  to  return. 

When  we  have  obtained  this  desirable  end,  will  our  neighbors  or 
other  nations  still  continue  to  fear  us;  and  will  they  place  restrictions 
on  our  trade  and  free  communication? 

Another  example:  Bubonic  plague  makes  its  appearance  on  the 
Pacific  coast  of  this  Republic.  Our  neighbors  of  the  north  and  south, 
as  well  as  in  the  West  Indian  Islands,  all  consider  themselves  threat- 
ened because  they  fear  that  our  government  has  not  the  necessary 
resources  with  which  to  prevent  the  spread  of  that  terrible  disease. 
But  within  a  space  of  six  months  we  see  the  disappearance  of  the  last 
vestige  of  the  plague,  and  our  neighbors  recovered  their  ease  of  mind 
while  we  acquired  a  fuller  confidence  in  our  own  resources. 

Gentlemen:  I  have  mentioned  these  examples  in  order  to  demon- 
strate how  great  is  the  obligation  under  which  we  all  stand  to  attend 
to  the  sanitation  of  our  cities,  and  not  only  to  the  great  centers  of 
population,  but  also  to  the  smaller  ones,  and  even  to  the  villages. 

Great  or  small  nations  are  formed  with  the  same  units ;  if  we  fail  to 
improve  the  sanitation  of  the  small  town,  that  town  might  become  a 
focus  from  which  the  disease  might  spread  itself  throughout  the  entire 
country.  We  should  always  begin  with  these  small  units;  we  should 
bring  to  the  attention  of  our  respective  Governments  the  idea  of  favor- 
ing sanitary  measures  everywhere.  If  small  towns  can  not  undertake 
their  sanitation,  they  will  request  the  help  of  the  states  to  which  they 
belong;  if  the  assistance  requested  can  not  be  rendered  by  the  states, 
these  will  call  upon  the  central  governments  for  such  help,  and  these 
latter  ones  should,  in  turn,  consider  that  the  sanitation  of  towns  is  less 


22  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

expensive  and  causes  less  detriment  to  the  welfare  of  the  people 
than  the  combatting  of  epidemics. 

Honorable  Delegates :  In  the  secular  evolution  of  humanity,  civiliza- 
tion has  extended  from  the  Orient  to  the  Occident.  We  who  inhabit 
the  Western  Hemisphere  should  now  avail  ourselves  of  the  very  rich 
legacy  left  by  Europe,  but  it  is  not  sufficient  that  we  take  and  preserve 
it;  we  should,  besides,  improve  it  with  the  wealth  of  our  own  inspira- 
tion. It  is  indispensable  that  these  new  countries  should  abandon  the 
principle  that  guided  our  predecessors  in  their  legislation  of  interna- 
tional sanitary  policy;  they  laid  down  the  principle  that  the  first  point 
was  to  look  to  their  defense  even  though  such  defense  might  injure 
the  interests  of  those  from  whom  they  defended  themselves.  This 
practice  has  been  followed  up  to  our  times;  it  is  nothing  to  us  if  the 
trade  and  wealth  of  a  nation  suffers  if  through  such  suffering  we 
obtain  an  advantage.  Let  us  try  to  obtain  a  healthier  and  more  liberal 
view  of  matters,  and  not  defend  our  legitimate  interests  by  wounding 
those  of  others;  let  us  be  more  practical  and  more  humane;  let  us 
not  look  upon  our  unfortunate  brethren  as  enemies,  whatever  may  be 
their  title  or  nationality,  through  the  mere  fact  that  they  are  sick;  let 
us  not  fight  against  our  fellow  man  or  injure  his  interest,  but  let  us 
rather  treat  him  as  a  brother,  isolating  him  so  that  he  may  not  hurt  us, 
but  allowing  his  goods  to  have  free  transportation.  Let  all  the  nations 
of  America  unite  in  one  league  against  disease,  and  for  the  old  rule 
let  us  substitute  this : 

"To  defend  our  legitimate  interests  without  injury  or  doing  the  least 
possible  injury  to  others." 

I  must  express  the  hope  that  this  principle,  more  Christian  and  more 
humane,  will  govern  the  deliberations  which  this  conference  is  about 
to  commence.  Let  us  not  forget,  gentlemen,  that  we  are  going  to 
labor  together  for  the  preservation  of  the  health  of  all,  for  the 
prolongation  of  individual  life,  and  for  the  increased  vigor  and  perfec- 
tion of  the  human  species.  (Applause.) 

I  bid  you  welcome.     (Applause.) 

THE  CHAIRMAN.  The  Delegate  from  Brasil  has  the  floor. 

THE  DELEGATE  FROM  BRASIL.  Mr.  Vice-President  of  the  Republic 
and  Secretary  of  the  Interior;  Mr.  Chairman  and  Members  of  the 
Convention:  The  Government  of  Brasil  has  intrusted  me  with  the 
mission  of  conveying  its  most  cordial  regards  to  the  Mexican  Govern- 
ment, our  noble  host;  the  same  regards  I  extend  to  the  Sanitary  Con- 
ference here  assembled,  with  my  Government's  sincere  wishes  for  the 
complete  success  of  the  work  today  inaugurated.  The  Brazilian  Gov- 
ernment wishes  me  to  express  also  the  great  interest  which  it  takes  in 
all  sanitary  matters,  because  it  considers  public  health  as  the  basis 
for  the  progress  of  nations.  For  that  reason,  it  has  always  a  great 
desire  to  contribute  and  co-operate  in  all  undertakings  tending  to  the 
advancement  of  international  hygiene,  either  sending  its  representa- 
tives to  Sanitary  Congresses,  or  considering  as  a  great  distinction  and 
honor  the  selection  of  its  territory  as  the  seat  of  such  useful  assem- 
blies. (Applause.) 

THE  CHAIRMAN.  The  Delegate  from  Colombia  has  the  floor. 

THE  DELEGATE  FROM  COLOMBIA.  Mr.  Vice-President  of  the  Republic, 
Mr.  Chairman  of  the  Convention,  Messrs.  Delegates:  For  the  first 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  23 

"V 

time  the  Republic  of  Colombia  participates  in  these  Conferences ;  cir- 
cumstances, the  mentioning  of  which  is  not  pertinent,  prevented  our 
Nation  from  sending  representatives  to  the  two  previous  and  very 
interesting  Conventions;  thanks  to  the  favorable  conditions  now  pre- 
vailing in  Colombia,  and  to  the  good  administration  that  manages  the 
national  affairs,  our  Government  has  been  able  to  honor  my  co-delegate 
and  myself  with  its  representation  so  that  we  may,  in  its  name,  accept 
all  agreements  that  in  accordance  with  truth  may  be  adopted  by  the 
Convention,  and  to  avail  ourselves  of  these  favorable  circumstances 
so  that  our  progress  and  commerce  may  follow  the  path  of  those  of 
other  nations. 

With  great  pleasure,  enthusiasm  and  admiration  we  see  in  the  report 
presented  by  the  Chairman  of  the  Convention,  Dr.  Liceaga,  examples 
so  palpable  and  recent  that  we  are  imbued  with  a  desire  to  do  our  duty. 
In  accepting  the  welcome,  my  Government,  not  only  has  given  us  the 
power  to  express  our  gratitude  for  the  kind  hospitality  extended  to  us, 
but  also  to  accept  with  pleasure  all  scientific  measures  that  may  be 
adopted  by  this  Convention.  (Applause.) 

THE  CHAIRMAN.  The  Delegate  from  Costa  Rica  has  the  floor. 

THE  DELEGATE  FROM  COSTA  RICA.  Mr.  Vice-President  of  the  Re- 
public; Mr.  Chairman  of  the  Convention;  Messrs.  Delegates:  In  the 
name  of  the  Government  and  the  people  of  my  country,  whom  I  have 
the  honor  to  represent  in  this  most  important  Convention,  I  have  the 
pleasure  of  extending  my  most  cordial  greetings  to  the  Mexican  Gov- 
ernment and  people.  The  success  that  will  be  attained  by  this  cam- 
paign, so  nobly  and  vigorously  undertaken  by  wisdom  and  experience 
against  the  great  foes  of  the  Continent,  will  be  a  new  leaf  added  to  the 
crown  of  unfading  glory  that  encircles  the  lofty  head  of  the  noble 
Mexican  Nation.  (Applause.) 

THE  CHAIRMAN.  The  Delegate  from  Cuba  has  the  floor. 

THE  DELEGATE  FROM  CUBA.  Mr.  Vice-President  of  the  Republic; 
Mr.  Chairman  of  the  Convention ;  Messrs.  Delegates :  In  the  name  of 
Cuba  we  greet  the  Mexican  Nation,  and  the  Delegates  of  the  Republics 
of  the  Continent,  and  we  express  our  gratitude  for  the  cordial  wel- 
come. (Applause.) 

THE  CHAIRMAN.  The  Delegate  from  Chile  has  the  floor. 

THE  DELEGATE  FROM  CHILE.  Mr.  Vice-President  of  the  Republic; 
Mr.  Chairman  of  the  Convention;  Messrs.  Delegates:  We  have  the 
honor  to  introduce  ourselves  to  the  Third  Pan-American  Sanitary  Con- 
vention as  the  Delegates  from  Chile,  my  distinguished  colleague, 
Doctor  Pedro  Lautaro  Ferrer,  and  myself. 

The  Republic  of  Chile  hastened  to  send  us,  always  wishing  to  fulfill 
the  promise  made  to  take  part  in  all  scientific  tournaments,  and  very 
specially  when  they  have  such  a  remarkable  significance  of  confra- 
ternity and  international  mutual  co-operation  as  the  present  one. 

Upon  entering  in  this  Convention,  our  first  manifestation  is  to 
address  a  cordial  greeting  to  the  high  personality  of  the  Chief  of  the 
Great  Mexican  Nation,  His  Excellency  General  Porfirio  Diaz,  world- 
renowned  statesman,  who  knows  how  to  execute  his  high  duties  with  a 
delicate  attention  to  scientists. 

We  do  not  doubt  for  a  moment  that  this  Convention  will  be  success- 
ful, and  we  hope  that  the  City  of  Mexico  will  have  the  honor  of  seeing 


24  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

realized  the  first  practical  measures,  fruit  of  the  first  two  Sanitary 
Conferences. 

I  will  close,  gentlemen,  sending  our  very  cordial  greetings  to  all  the 
American  Republics  through  the  illustrious  Delegates  that  honor  this 
Convention,  and  offering  them  the  share  of  our  good  will  to  help  them 
with  enthusiasm  in  the  realization  of  the  great  international  work  which 
we  inaugurate  today.  (Applause.) 

THE  CHAIRMAN.  The  Delegate  from  Ecuador  has  the  floor. 

THE  DELEGATE  FROM  ECUADOR.  This  is  the  first  time  that  my  Gov- 
ernment sends  a  representation  to  the  Sanitary  Conventions,  and  it  is 
with  pleasure  that  it  now  participates  in  the  present  one.  In  the  name 
of  my  Government,  I  thank  you  for  your  kind  welcome.  (Applause.) 

THE  CHAIRMAN.  Dr.  Wyman,  Delegate  from  the  United  States,  has 
the  floor. 

DR.  WYMAN  declared  that  it  was  not  necessary  to  express  the  pleas- 
ure of  himself  and  the  other  American  Delegates  at  being  in  Mexico 
on  this  occasion. 

The  American  Delegate  spoke  of  the  great  interest  which  is  inspired 
by  the  present  Convention  and  of  the  many  matters  of  importance 
which  will  be  transacted  therein ;  of  the  great  benefits  which  would  be 
derived  by  association,  through  this  Convention,  of  the-  American 
Republics  with  the  great  countries  of  Europe. 

THE  CHAIRMAN.  The  Delegate  from  Guatemala  has  the  floor. 

THE  DELEGATE  FROM  GUATEMALA.  .  Mr.  Vice-President  of  the  Re- 
public; Mr.  Chairman  of  the  Convention;  Messrs.  Delegates:  The 
Guatemalan  Delegation,  through  me,  has  the  honor  of  greeting  the 
illustrious  Government  of  Mexico,  the  Mexican  .Delegation,  whose  most 
meritorious  labors  will  tie  crowned  with  the  most  gratifying  success  in 
this  Convention,  and  the  cultured  and  .hospitable  Mexican  people. 

President  Manuel  Estrada  Cabrera,  of  Guatemala,  who  has  initiated 
in  my  country  important  sanitary  works,  upon  accepting  with  pleasure 
the  invitation  of  the  International  Sanitary  Bureau  of  Washington,  and 
of  the  Mexican  Government,  to  participate  in  the  present  Conference, 
has  considered  that  its  benefits  will  be  manifold  not  only  for  this 
beautiful  country  but  also  for  each  and  every  nation  here  represented. 
The  Guatemalan  Delegation  can  not  but  have  the  same  opinion,  and 
makes  the  most  fervent  vows  for  the  happy  crowning  of  the  work  that 
is  to  be  undertaken,  and  for  the  personal  happiness  of  the  illustrious 
members  of  the  Mexican  Government,  of  the  Delegates  of  this  Con- 
vention, and  of  the  Mexican  people.  (Applause.) 

THE  CHAIRMAN.  The  Delegate  from  Honduras  has  the  floor. 

THE  DELEGATE  FROM  HONDURAS.  Mr.  Vice-President  of  the  Re- 
public; Mr.  Chairman  of  the  Sanitary  Convention;  Messrs.  Delegates: 
The  Republic  of  Honduras  has  accepted  the  invitation  that  was  ex- 
tended to  it  to  participate  in  this  Convention ;  it  requested  me  to  greet 
through  the  President  of  the  Republic  the  great  nation  of  the  Occident, 
north  of  us,  which  has  always  attracted  our  attention  on  account  of 
her  progress.  I  also  wish,  gentlemen,  to  thank  you  for  the  attentions 
that  have  given  us  the  right  to  take  part  in  this  Convention,  and  I 
believe  that  if  all  that  would  result  from  this  Convention  were  only  a 
knowledge  of  what  Mexico  has  accomplished  in  sanitation,  we  would 
be  satisfied  with  our  work.  (Applause.) 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  25 

THE  CHAIRMAN.  The  Delegate  from  Nicaragua  has  the  floor. 

THE  DELEGATE  FROM  NICARAGUA.  Mr.  Vice-President  of  the  Re- 
public; Mr.  Chairman;  Messrs.  Delegates:  In  the  name  of  the  Gov- 
ernment of  Nicaragua,  whom  I  have  the  high  honor  to  represent  in 
this  Sanitary  Convention,  I  bring,  in  the  first  place,  a  message  of 
affection  to  our  great  sister  Republic,  and  of  congratulation  for  the 
extraordinary  progress  she  has  achieved  in  all  branches,  and  specially, 
as  we  have  just  now  heard  in  the  speech  of  the  Vice-President  of  the 
Republic,  in  that  of  hygiene,  which  so  much  distinguishes  the  countries 
that  have  reached  a  high  degree  of  civilization. 

I  congratulate  and  greet  all  my  colleagues,  all  the  envoys  of  the 
Republics,  who  understand  the  high  importance  of  the  mission  that 
has  been  entrusted  to  them,  and  who  come  here  animated  by  the. best 
desire  to  bring  to  us  their  share,  as  progressive  Republics,  as  a  useful 
contribution  to  the  great  work:  I  congratulate  the  Mexican  Republic 
which  has  achieved  such  a  high  degree  of  progress  under  the  wise  and 
patriotic  administration  of  that  most  learned  and  prudent  man,  of 
universal  fame,  as  the  Delegate  from  the  United  States  has  just  now 
said;  I  congratulate  Dr.  Liceaga  for  the  splendid  manifestation  and 
program  which  he  has  brought  us  here,  of  the  efforts  exerted  by  coun- 
tries to  fight  the  great  plagues  that  destroy  humanity,  and  that  have 
caused  the  fighting  of  such  plagues  up  to  their  very  origin. 

To  conclude,  gentlemen,  I  make  fervent  vows  that  the  labors  of  this 
Convention,  today  assembled  for  the  third  time,  may  achieve  the 
ideals  that  it  aims  for,  and  that  we  may  codify,  as  Dr.  Liceaga  sard, 
the  laws  of  every  country  and  collectively  of  all  the  other  nations. 
(Applause.) 

THE  CHAIRMAN,  The  Delegate  from  Salvador  has  the  floor. 

THE  DELEGATE  FROM  SALVADOR;  Mr.  Vice-President  of  the  Republic ; 
Mr.  Chairman  of  the  Convention;  Messrs.  Delegates:  Having  been 
honored  by  the  Supreme  Government  of  Salvador  with  its  representa- 
tion before  the  Third  International  Sanitary  Convention,  I  beg  leave, 
in  the  first  place,  to  greet,  in  the  name  of  the  Salvadorean  Government 
and  People,  the  Government  and  People  of  Mexico  in  the  illustrious 
personality  of  its  most  worthy  First  Magistrate,  the  eminent  General 
Porfirio  Diaz,  originator  of  the  wonderful  progress  of  this  great 
Nation,  and  to  present  my  kind  respects  to  His  Excellency  the  Vice- 
President  of  the  Republic ;  to  His  Excellency  the  illustrious  veteran  of 
diplomacy,  Senor  Don  Ignacio  Mariscal,  today  indisposed  by  an  illness 
from  which  we  hope  he  will  soon  recover;  to  the  Chairman  of  this 
Convention,  the  learned  Dr.  Liceaga,  a  physician  of  universal  reputa- 
tion, to  whom  public  health  owes  so  much,  and  who  has  spent  the 
greater  part  of  his  life  and  of  his  inextinguishable  energies  in  the 
carrying  out  of  so  many  sanitary  works,  such  as  the  sanitation  of  this 
beautiful  capital,  the  pride  of  Mexico;  and  finally,  to  each  of  the 
Honorable  Delegates  of  the  various  Nations  here  assembled. 

Having  fulfilled  this  duty  of  courtesy,  so  pleasantly  gratifying  for 
me,  I  only  have  to  solemnly  assure  you  that  the  Government  which  I 
represent  will  do  all  that  is  within  its  power  to  carry  out  the  wise 
resolutions  that  may  be  adopted,  and  that  it  will  faithfully  fulfill  all  the 
obligations  that  it  may  contract  in  this  Convention.  (Applause.) 

THE  VICE-PRESIDENT  OF  THE  REPUBLIC.  Today,  the  second  of  De- 


26  THIRD    INTERNATIONAL   SANITARY    CONVENTION. 

cember,  nineteen  hundred  and  seven,  the  Third  International  Sanitary 
Convention  of  American  Republics  is  solemnly  inaugurated  in  the  City 
of  Mexico.  (Applause.) 

THE  CHAIRMAN.  I  move  that  the  representatives  of  the  Nations  that 
have  accepted  the  invitation  extended  to  them,  be  made  Vice-Presidents 
of  the  Convention.  I  have  taken  the  liberty,  and  I  hope  you  will  excuse 
me  for  it,  to  appoint  Dr.  Walter  Wyman  as  Vice-President ;  he  has 
been  the  President  of  the  previous  Conventions,  and  I  thought  that  this 
fact  places  him  in  exceptional  conditions.  I  hope  my  action  will  meet 
with  your  approval.  (Applause.) 

I  beg  to  submit  the  following  names,  by  order  of  nations,  for  Vice- 
Presidents  : 

Doctor  Walter  Wyman,  United  States. 
Doctor  Oswaldo  Goncalvez  Cruz,  Brazil. 
Doctor  Ricardo  Gutierrez  Lee,  Colombia. 
Doctor  Juan  J.  Ulloa,  Costa  Rica. 
Doctor  Juan  Guiteras,  Cuba. 
Doctor  E.  Soza,  Chile. 
Doctor  J.  H.  Estevez,  Ecuador. 
Doctor  Salvador  Ortega,  Guatemala. 
Doctor  Luis  Lazo  Arriaga,  Honduras. 
Doctor  Gregorio  Mendizabal,  Nicaragua. 
Doctor  Rodolfo  B.  Gonzalez,  Salvador. 

I  wish  to  know  if  the  appointment  of  Vice-Presidents  in  the  persons 
I  have  mentioned  meets  with  your  approval.     (Applause.) 
Motion  approved. 

For  the  purpose  of  studying  the  different  subjects  to  be  taken  up 
before  the  Convention,  the  Chairman  appointed  the  following  com- 
mittees : 

Committee  on  Credentials. — Lie.  Jose  D.  Algara,  Dr.  Rhett  Goode 
and  Dr.  S.  Ortega. 

Committee  on  Council. — Drs.  Eduardo  Liceaga,  Walter  Wyman, 
Juan  Ulloa,  E.  Laza,  L.  Gutierrez  Lee. 

Committee  on  Yellow  Fever. — Drs.  Juan  Guiteras,  R.  H.  von  Ezdorf, 
O.  Gonzalez  Cruz  and  W.  G.  Owen. 

Committee  on  Bubonic  Plague. — Drs.  P.  L.  Ferrer,  E.  Liceaga  and 
P.  F.  Straub. 

Committee  on  Trachoma,  Beri-beri  and  Cerebro-Spinal  Meningitis.— 
Drs.  James  Gatewood,  G.  Mendizabal  and  H.  Roberts. 

Committee  on  Tuberculosis. — Drs.  H.  L.  E.  Johnson,  J.  Azurdia,  L. 
Lazo  Arriaga,  G.  Payan,  R.  B.  Gonzalez  and  J.  H.  Esteva. 

THE  CHAIRMAN.  The  appointment  of  these  Committees  is  submitted 
to  the  approval  of  the  Convention. 
Approved. 

THE  CHAIRMAN.  In  order  that  we  may  devote  the  very  brief  space 
of  time  during  which  we  will  be  assembled,  and  to  avoid  interpellations 
as  well  as  the  calling  to  order  any  delegate  for  following  strictly  the 
parliamentary  rules,  I  request  the  Members  of  the  Convention  to 
accept  as  rules  those  that  appear  in  the  programme  distributed  among 
all  the  Governments;  as  to  the  subjects  that  will  be  considered,  it  is 
established  as  a  rule  that  the  detailed  reports  presented  by  the  different 
Delegates  will  be  read  before  the  Convention  in  the  form  of  a  resume, 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  2/ 

the  perusal  of  which  shall  not  exceed  fifteen  minutes,  but  their  publica- 
tion will  be  in  full.  I  request  the  Delegates  that  they  observe  the 
following  rules,  purely  conventional,  in  case  they  are  accepted : 

In  order  that  the  time  of  the  convention  may  be  not  taken  up  with 
other  than  technical  matters  the  Delegates  are  requested  to  kindly  sub- 
mit, during  the  programs  of  the  meeting,  to  the  following  rules : 

i. — The  Delegates  will  be  called  from  the  list  in  the  alphabetical 
order  of  the  countries  which  they  represent. 

2. — Conforming  to  article  7  of  the  temporary  program  the  Delegates 
will  present  an  extract  of  their  reports  or  treatise,  but  the  reading  will 
occupy  not  to  exceed  fifteen  minutes. 

3. — During  discussions  the  speakers  will  be  allowed  the  floor  but  five 
minutes. 

4. — All  Delegates  who  have  the  floor  and  who  desire  their  speeches 
placed  on  the  record  will  submit  them  in  writing  to  the  Secretary  at 
the  same  session  during  which  it  is  delivered. 

5. — No  delegate  will  be  permitted  to  speak  more  than  twice  on  the 
same  subject,  except  the  person  making  the  motion,  who  is  supposed 
to  reply  to  all  objections  thereto. 

6.  Every  resolution  or  motion  on  any  subject  submitted  to  this  Con- 
gress should  be  referred  to  the  Advisory  Committee,  which  will  study 
the  subjects  and  decide  whether  or  not  they  should  be  submitted  to  the 
consideration  of  the  Congress. 

Shall  it  be  approved?    It  was  approved. 

Gentlemen:  I  beg  to  remind  you  that  our  regular  session  will  be 
held  at  3  o'clock  in  this  same  place,  and  that  tonight  at  8  o'clock  the 
Superior  Council  of  the  Federal  and  Municipal  Governments  will  give 
a  banquet  in  your  honor  at  the  Municipal  Palace. 

The  session  adjourned. 


Afternoon  Session. 

The  afternoon  session  was  called  to  order  at  3  o'clock. 

The  report  of  the  Committee  on  Credentials  was  approved  without 
discussion,  and  reads  as  follows: 

"The  undersigned,  members  of  the  Committee  on  Credentials  of  the 
Third  International  American  Sanitary  Convention,  having  examined 
the  credentials  submitted  to  them,  as  well  as  the  diplomatic  notes  on 
file  in  the  Department  of  Foreign  Relations  on  Mexico,  relating  to  the 
appointment  of  delegates  to  said  Convention,  recommend  that  the  cre- 
dentials of  the  persons  stated  below  be  approved : 

Brazil:     Doctor  Oswaldo  Gongalvez  Cruz. 

Colombia :     Doctors  Ricardo  Gutierrez  Lee,  and  Ricardo  Payan. 

Costa  Rica :     Doctor  Juan  Jose  Ulloa. 

Cuba :     Doctors  Hugo  Roberts,  and  Juan  Guiteras. 

Chile:     Doctors  Ernesto  Sosa,  and  Pedro  Lautaro  Ferrer, 

Ecuador :     Doctor  Juan  Horacio  Esteves. 

United  States :  Doctors  Walter  Wyman,  R.  H.  von  Ezdorf,  P.  T. 
Straub,  James  Gate  wood,  Charles  Harrington,  W.  G.  Owen,  Rhett 
Goode,  and  H.  L.  E.  Johnson. 

Guatemala:     Doctors  Salvador  Ortega,  and  J.  Azurdia. 


28  THIRD   INTERNATIONAL    SANITARY    CONVENTION. 

Honduras :     Dr.  Luis  Lazo  Arriaga. 

Mexico:  Doctor  Eduardo  Liceaga,  Dr.  Jose  Algara,  Engineer 
Hilario  Elguero. 

Nicaragua:     Doctor  Gregorio  Mendizabal. 

Salvador:    Doctor  Rodolfo  B.  Gonzalez. 

Uruguay:     Doctor  Ernesto  Fernandez  Espiro. 

Mexico,  December  2,  1907. — Jose  Algara,  Rhett  Goode,  Salvador 
Ortega." 

Dr.  Johnson,  Delegate  of  the  United  States,  moved  that  the  Consul- 
General  of  the  United  States  in  Mexico,  Dr.  W.  M.  Brumby,  Dr.  John 
Frick,  and  Dr.  J.  H.  Stolpen,  be  allowed  to  attend  the  sessions.  This 
motion  was  approved. 

The  Chairman:  Let  us  commence  our  scientific  work.  The  dele- 
gate of  Brazil  has  the  floor,  and  will  read  the  extract  of  the  paper 
he  submits  to  the  Convention  in  accordance  with  the  rules  and  regu- 
lations approved  by  this  Convention. 

The  delegate  from  Brazil  read  the  extract  which  appears  in  the 
appendix,  page  137. 

Doctors  Gutierrez  Lee,  Ulloa,  Roberts,  Ferrer,  Wyman,  Lazo  Ar- 
riaga, and  Liceaga,  delegates  of  Colombia,  Costa  Rica,  Cuba,  Chile, 
Honduras,  United  States,  and  Mexico,  respectively,  then  read  extracts 
of  their  essays. 

The  reports  which  do  not  appear  below  will  be  found  in  full  in  the 
appendices. 

Doctors  Azurdia,  of  Guatemala,  and  Gonzalez,  of  Salvador,  re- 
quested to  be  allowed  to  read  their  reports  at  tomorrow's  session,  and 
the  delegate  of  Nicaragua  said  that  he  would  submit  his  report  as  soon 
as  he  received  the  data  which  he  had  asked  the  Government  he  repre- 
sents to  furnish  him. 

Dr.  Julian  J.  Ulloa,  delegate  of  Costa  Rica,  read  a  summary  of  the 
report  referred  to  in  the  provisional  program  of  the  Convention.  (See 
Appendix,  page  160. 

The  delegate  of  Honduras  read  an  extract  from  the  report  he  will 
submit  in  accordance  with  the  program  of  the  Convention.  (See 
Appendix,  page  173. 

THE  CHAIRMAN.  It  would  not  be  possible  for  me  to  make  extracts 
from  the  report  presented  by  the  Mexican  delegation,  and  for  this 
reason,  I  shall  only  make  brief  remarks  in  connection  with  each  one 
of  them,  in  the  short  time  at  my  disposal. 

YELLOW  FEVER. 

Regarding  yellow  fever,  I  shall  limit  my  remarks  to  a  very  few 
words. 

The  campaign  which  has  been  waged  during  four  years,  and  as 
I  said  in  the  address  I  had  the  honor  to  read  to  this  Convention,  enabled 
us  to  destroy  this  epidemic  in  three  months  on  the  entire  Gulf  coast, 
and  even  the  epidemic  which  extended  to  the  interior  of  the  country 
we  controlled  easily  and  completely,  there  remaining  latent  only  the  old 
foci  of  Veracruz  and  northern  Yucatan.  The  disease  has  also  appeared 
periodically  in  Tampico,  and  the  intervals  of  these  outbreaks  some- 
times have  been  as  long  as  20  years,  to  such  an  extent  that  persons 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  29 

who  were  considered  immune  became  again  subject  to  the  disease, 
but  since  November  3,  1903,  there  has  not  occurred  a  single  case. 

As  I  stated  in  the  report  I  read  this  morning,  no  more  than  five 
cases  of  yellow  fever  have  developed  this  year,  distributed  as  follows : 

Two  cases  occurred  on  February  7th  in  a  small  village  called  Paraje 
Nuevo,  in  the  Canton  of  Cordoba,  State  of  Veracruz,  one  of  which  was 
discovered  immediately,  and  the  other  patient  went  to  Veracruz,  where 
he  was  isolated,  and  died  on  the  Qth  of  the  same  month.  The  patient 
of  Paraje  Nuevo  was  entirely  isolated  as  soon  as  it  was  discovered 
that  he  had  yellow  fever,  and  no  more  cases  occurred. 

There  was  another  case  at  Veracruz  on  September  5th,  and  I  simply 
mention  it  for  the  information  of  the  delegates  who  are  familiar  with 
this  disease,  so  that  they  may  take  it  into  consideration.  Said  case 
was  developed  in  the  following  manner:  There  is  a  building  at  the 
port  of  Veracruz,  which  the  delegates  have  just  seen,  namely,  the 
lighthouse  office,  situated  more  than  500  meters  from  the  wharf,  and 
which  has  just  been  built  and  decorated,  the  furniture  thereof  being 
entirely  new.  The  only  person  living  there  was  the  keeper,  and  he 
was  taken  sick  on  September  5th.  The  two  physicians  who  were 
called  said  it  was  a  case  of  yellow  fever.  The  patient  had  entirely 
recovered  by  the  I2th.  Two  cases  occurred  in  Merida,  one  on  the 
1 9th  and  another  on  the  2ist  of  March,  and  as  soon  as  they  were 
discovered  the  patients  were  isolated  and  the  small  foci  of  infection 
disappeared. . 

These  are  all  the  cases  of  yellow  fever  which  have  occurred  through- 
out the  Republic. 

Said  cases  have  been  described  in  the  report,  and  I  consider  it  un- 
necessary to  go  into  further  detail  concerning  them,  but  I  now  beg 
to  make  a  description  of  our  organization  for  protection  against  yellow 
fever.  This  organization  has  its  headquarters  at  this  Capital,  and  is 
represented  by  a  single  sanitary  corps,  namely,  The  Superior  Board 
of  Health,  under  the  Department  of  Gobernacion  (Interior),  which 
receives  daily  reports  from  all  the  sections  of  the  Republic,  and  tele- 
graphic reports  of  such  new  cases  as  may  occur,  said  reports  com- 
prising the  following  points : 

New  cases  on  the  day  the  telegraphic  report  is  made. 

Total  number  of  cases  from  the  first  day  of  the  year. 

Those  who  have  sufficiently  recovered  to  leave  the  hospital  on  the 
date  the  report  is  made. 

Deaths  occurring  on  the  date  of  the  report. 

Total  number  of  deaths  from  the  first  day  of  the  year. 

New  foci  of  infection  on  the  date  of  the  report. 

Total  number  of  foci  from  the  first  day  of  the  year. 

Patients  actually  suffering  from  yellow  fever  who  have  been  sub- 
mitted to  treatment. 

Persons  suspected  of  having  the  disease  who  were  Isolated  on  the 
day  of  the  report. 

Calls  made  at  the  dwellings  of  immunes. 

Calls  made  at  the  dwellings  of  persons  not  immune,  to  ascertain  if 
there  are  any  fever  patients. 

Cases  on  trains. 

Emptied  water  deposits. 


3O  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

Water  deposits  treated  with  petroleum. 

Wells  treated  with  petroleum. 

This  daily  report  enables  us  to  discover  the  first  suspicious  case  that 
may  occur.  The  rules  which  the  sanitary  brigades  observe  in  their 
operations  are  the  following :  As  soon  as  the  fever  of  a  patient  cannot 
be  diagnosed  as  pneumonia  or  some  other  disease,  said  patient  is 
isolated,  and  the  house  in  which  he  lodged,  as  well  as  the  surrounding 
houses,  are  disinfected. 

Visits  to  houses  of  persons  who  are  not  immune  are  made  in  order 
to  determine  if  there  are  any  cases  of  illness  therein. 

Now  I  will  take  the  liberty  to  show  you  some  drawings  which  indi- 
cate how  these  visits  are  made  in  Merida  and  Veracruz. 

Finally,  we  have  one  single  center,  namely,  the  Superior  Board  of 
Health,  which  receives  daily  reports,  and  brigades  that  may  be  mobil- 
ized as  circumstances  require.  Since  I  have  no  time  to  discuss  these 
points,  I  beg  you, to  look  at  the  pictures  which  I  have  made  to  that 
end  and  which  will  now  be  placed  on  the  table. 

BUBONIC  PLAGUE. 

Concerning  this  subject,  I  have  to  inform  the  delegates  that  since 
the  month  of  May,  1903,  there  has  not  occurred  a  single  case  of  bubonic 
plague  in  Mexico,  and  I  should  add  that  we  succeeded  in  entirely  elim- 
inating this  disease  in  six  months.  A  circular  has  been  distributed 
among  you,  which  I  shall  submit  to  your  consideration,  and  from 
which  I  shall  now  proceed  to  make  some  brief  extracts. 

I.  In  order  to  extinguish  a  transmissible  disease  in  a  city,  the  first 
step  that  should  be  taken  is  to  remove  the  receptive  element,  that  is  to 
say,  to  diminish  the  population;  but  this  should  be  done  on  the  condi- 
tion that  only  healthy  persons  shall  leave  the  town,  and  in  order  to 
obtain  this  result,  we  established  a  vigilance  service  on  all  those  who 
leave  the  town. 

It  is  the  duty  of  the  commission  appointed  to  issue  certificates  to  all 
hale  persons,  and  as  soon  as  they  have  obtained  these  certificates  they 
may  leave  the  town,  and  we  established  this  first  rule :  It  is  necessary 
to  cause  the  greatest  possible  number  of  healthy  persons  to  leave  an 
infested  town. 

Second.  All,  or  at  least  the  greater  part,  of  the  inhabitants  of  the 
infested  town  should  be  vaccinated. 

In  Mazatlan,  3,575  persons  were  vaccinated,  and  the  results  ob- 
tained at  Villa  Union  were  really  wonderful,  because  all  persons  who 
were  not  ill  were  vaccinated.  Before  this  operation  was  carried  out, 
there  occurred  34  cases,  9  of  which  were  fatal.  As  soon  ss  the  disease 
developed,  all  healthy  persons  were  vaccinated  and  the  epidemic  dis- 
appeared. 

Ordinary  means  are  not  sufficient  to  discover  suspicious  cases  of 
diseases.  It  is  the  duty  of  physicians  to  report  cases  of  yellow  fever, 
bubonic  plague,  cholera,  and  other  plagues;  but  they  cannot  be  ex- 
pected to  divine  the  diseases,  so  that  until  they  have  made  their  diag- 
nosis, they  can  not  make  such  a  report.  Then  we  established  a  system 
of  house  to  house  visits,  which  consists  in  calling  at  the  house  in  order 
to  find  out  if  any  persons  are  ill  therein,  but  physicians  do  not  ask 
whether  there  are  any  persons  ill,  but  go  into  the  house  in  an  arbitrary 


THIRD    INTERNATIONAL-  SANITARY    CONVENTION.  3! 

manner,  and  surprise  the  patients,  so  that  these  visits  are  made  with- 
out the  consent  of  the  residents. 

It  is  necessary  to  isolate  all  the  patients,  the  same  as  is  done  in  the 
case  of  all  transmissible  diseases,  but  this  isolation  must  be  done  as 
follows :  The  suspected  cases  are  kept  in  a  special  department.  Any 
one  having  fever  and  swelling  of  the  glands  is  regarded  as  suspicious. 
Those  who  really  have  the  plague  are  sent  to  the  lazaretto,  where  there 
are  two  departments,  one  for  those  who  actually  have  the  bubonic 
plague,  and  the  other  for  convalescents,  because  it  has  been  demon- 
strated that  the  disease  is  transmissible  even  four  weeks  after  the 
patient  has  been  cured. 

The  persons,  who  had  been  near  the  patient  remained,  and  tents  and 
barracks  were  provided  for  them,  situated  a  considerable  distance 
from  the  town,  and  there  they  were  fed  and  provided  with  clothes. 
This  was  a  novelty  we  introduced,  that  is  to  say,  we  furnished  all 
applicants  with  new  clothes  in  place  of  the  old  ones.  The  disinfection 
was  made  in  old  houses  after  the  patient  had  left  the  premises,  but 
inasmuch  as  in  all  our  towns,  and  especially  those  situated  in  the  hot 
lands,  there  are  many  houses  of  reeds  or  canes,  the  roofs  of  which 
consist  of  dry  grass,  and  it  being  impossible  to  make  a  thorough 
disinfection,  we  decided  to  burn  said  huts.  Therefore,  we  burnt  60 
huts  in  Mazatlan. 

In  order  to  check  the  disease  in  the  suburbs  of  the  town,  we  did 
the  following:  Sanitar«y  stations  were  established,  which  it  was  pos- 
sible to  do,  because  at  the  time  there  was  no  railroad  running  out  of 
Mazatlan.  After  a  journey  by  carriage  or  horseback,  the  first  sanitary 
station  was  established  and  a  second  one  was  established  at  an  equal 
distance,  and  still  another  established  also  at  the  same  distance  as 
the  previous  one,  and  so  on  to  the  towns  bordering  on  the  State  of 
Sinaloa.  If  any  patient  escaped  clandestinely  from  Mazatlan,  he  was 
recognized  at  the  first  station,  and  if  the  disease  was  not  discovered 
there,  it  was  discovered  in  the  following  one,  or  at  the  third  station, 
and  -since  at  the  station  they  furnished  information  concerning  the 
place  of  destination  of  the  patient,  it  was  possible  to  make*the  proper 
investigation  in  co-operation  with  the  civil  authorities  Of  the  different 
places  indicated,  and  to  sequestrate  the  patient  when  he  could  be 
found,  and  in  this  way  the  transmission  of  the  disease  was  prevented. 

I  am  going  to  show  you  a  drawing  illustrating  the  results  obtained. 

MALARIA. 

It  is  impossible  to  obtain  exact  data  concerning  malaria.  The 
number  of  patients  can  not  be  considered  as  exact  data,  because  there 
are  many  who  are  afflicted  with  said  disease,  and  yet  they  go  about 
the  streets  and  fulfil  their  duties,  and,  therefore,  it  is  impossible  for  the 
health  authorities  to  discover  all  the  cases  of  malaria. 

The  data  concerning  mortality  can  not  be  used  because,  as  to 
mortality,  the  physicians  only  state  the  immediate  cause  of  death,  in 
which  malaria  is  not  mentioned,  but  anemia  and  other  causes. 

This  is  the  reason  why  I  have  limited  myself  to  indicate,  by  means 
of  color§  on  the  map  of  the  Republic,  the  regions  wherein  this  disease 
more  or  less  frequently  prevails. 

But  now  I  am  going  to  propose  to  you  something  new  about  this 
subject,  and  which  I  submit  to  your  consideration. 


32  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

I  shall  not  dwell  on  the  means  of  combatting  malaria,  because  they 
are  well  known  to  everybody,  and  shall  limit  myself  to  propose  to  the 
delegates  to  wage  a  war  against  malaria  like  that  which  is  being  waged 
against  yellow  fever. 

If  we  succeed  in  convincing  everyone  that  it  is  within  his  power 
to  guard  himself  against  the  disease  by  avoiding  the  mosquito  bite 
which  produces  it,  simply  by  screening  the  doors  and  windows  of 
dwellings  with  wire  gauze  in  order  to  prevent  the  entrance  of  mos- 
quitoes, then  we  shall  have  advanced  far  in  this  direction.  My  propo- 
sition, therefore,  consists  in  making  an  efficient  propaganda  against 
malaria  by  advising  everyone  to  take  good  care  of  himself  and  avoid 
mosquito  bites.  This  accomplished,  the  action  of  the  authorities  will 
thereby  be  greatly  reduced. 

TRANSMISSIBLE  CHRONIC  DISEASES. 

There  is  yet  another  important  thing  to  add  to  the  international 
sanitary  police,  and  I  wish  to  call  your  attention  to  the  following  fact : 
Heretofore,  all  nations  have  devoted  their  attention  especially  to  the 
protection  against  acute  transmissible  diseases,  by  the  means  to  which 
I  have  already  referred,  but  experience  is  teaching  us  that  it  is  nec- 
essary to  defend  ourselves  against  transmissible  chronic  diseases. 

Trachoma,  beri-beri,  tuberculosis  and  malaria  have  just  been  men- 
tioned. Is  it  possible,  knowing,  as  we  do,  that  they  are  transmissible 
diseases,  and  consequently,  avoidable,  that  we  should  fail  to  devise  the 
necessary  means  to  prevent  them  ? 

I  call  your  attention  especially  to  tuberculosis,  trachoma  and  beri- 
beri, and  more  particularly  to  trachoma. 

I  have  just  heard  that  in  some  places  this  disease  is  entirely  un- 
known, but  so  far  as  our  country  is  concerned,  I  would  say  that  fre- 
quently vessels  arrive  at  our  ports  with  Chinese  immigrants  on  board, 
among  whom  there  are  usually  some  patients  suffering  from  trachoma. 
There  was  on  one  occasion,  I  remember,  I  was  compelled  to  re-embark 
220  patients  who  had  trachoma,  and  who  arrived  in  one  single  vessel 
which  brought  600  Chinese.  In  another  instance  I  caused  120  to  be 
re-embarked,  and  subsequently  I  had  to  again  re-embark  20  or  30 
more  patients  of  trachoma  every  month.  Therefore,  we  should  pre- 
vent the  entrance  of  persons  afflicted  with  trachoma.  A  law  is  now 
under  consideration  in  Mexico  to  prevent  the  admission  not  only  of 
this  kind  of  patients,  but  also  of  those  who  might  become  a  burden  to 
the  State  because  they  are  not  able  to  work,  so  that  the  lame,  the  one,- 
armed,  the  blind,  etc.,  who  are  unable  to  work,  shall  not  be  permitted 
to  enter  the  country. 

In  the  report  which  I  shall  submit  to  you  tomorrow,  will  appear 
the  appropriation  which  the  General  Government  of  Mexico  has  made 
for  the  sanitation  of  ports.  The  sanitary  conditions  of  the  port  of 
Tampico  are  now  being  improved,  and  trie  sanitation  of  the  ports  of 
Veracruz,  Coatzacoalcos,  Manzanillo,  and  Mazatlan  is  almost  completed, 
and  in  all  these  works  our  Government  has  spent  the  enormous  sum 
of  $45,800,000. 

TJie  reports  to  which  Dr.  Liceaga  made  a  brief  reference  will  be 
found  in  full  in  the  Appendix,  page  173. 

The  session  adjourned. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  33 


SECOND  DAY,  TUESDAY,  DECEMBER  3. 
Morning  Session. 

All  the  delegates  of  this  Convention  being  present,  except  those  of 
Chile,  the  session  was  called  to  order  at  n  A.  M.,  Dr.  Eduardo  Liceaga 
presiding. 

THE  CHAIRMAN.  I  beg  the  delegates  not  to  begin  this  session  by 
reading  the  minutes,  in  order  to  make  up  the  time  we  have  employed 
in  our  visit  to  the  Penitentiary.  Before  we  commence  our  regular 
business,  Dr.  Guiteras  will  take  the  floor  because  he  desires  to  make  a 
motion  which  will  be  referred  to  the  Advisory  Committee  to  be  con- 
sidered and  decided  upon  before  we  end  our  sessions,  to  determine 
whether  or  not  it  should  be  taken  into  consideration. 

Dr.  Guiteras  read  the  following  motion,  which,  in  accordance  with 
the  suggestion  of  the  Chairman,  was  referred  to  the  Advisory  Com- 
mittee for  consideration : 


ADAPTATION   OF  THE   CONVENTION   OF   WASHINGTON   TO  THE  EUROPEAN    COLONIES    IN 

AMERICA. 

"Whereas  the  Conference  of  Paris  of  1903  did  not  include  in  its  resolutions 
all  the  measures  required  for  combatting  yellow  fever,  which  measures  were 
adopted  by  the  Convention  of  Washington ; 

"Whereas  the  European  colonies  on  the  American  continent  are  not,  there- 
fore, guided,  so  far  as  yellow  fever  is  concerned,  by  the  same  convention  in 
force  in  the  American  Republics ; 

Whereas  some  of  said  colonies  are  frequently  the  foci  of  yellow  fever; 

It  is  recommended  that,  through  correspondence  to  be  established  between 
our  Permanent  Bureau  and  that  of  Paris,  the  plan  of  sanitary  measures  against 
yellow  fever,  adopted  at  the  Convention  of  Washington  in  1905,  be  submitted 
to  the  European  nations,  either  to  be  considered  by  them  separately,  or  to  be 
submitted  *to  the  next  Sanitary  Convention  of  European  States,  or  in  such 
other  manner  as  may  be  agreed  upon  between  the  two  permanent  Bureaus. 

''NATIONALIZATION  OF  SANITARY  SERVICES. 

"Whereas  the  success  obtained  on  this  Continent  within  the  last  few  years  of 
the  campaign  against  epidemic  diseases  is  due  to  the  intervention  of  Central 
Governments ; 

"Whereas  the  lack  of  means  on  the  part  of  local  authorities,  as  well  as  the 
serious  inconvenience  brought  about  by  dualism  in  the  sanitary  authorities,  has 
been  repeatedly  shown; 

"The  Convention  recommends  to  the  American  Nations  the  nationalization 
and  centralization  of  the  sanitary  authority  by  means  of  legislation,  and  the 
establishment  of  a  Department  of  Public  Health." 

THE  CHAIRMAN.  In  accordance  with  the  program  adopted,  the  read- 
ing of  the  extracts  which  are  to  be  presented  by  each  of  the  delegates, 
will  now  be  continued.  The  delegate  of  Guatemala  has  the  floor. 


34  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

The  delegate  of  Guatemala  then  read  his  report,  which  was  not  read 
in  a  former  session  for  the  reasons  which  he  has  already  explained. 
(See  Appendix,  page  171.) 

THE  CHAIRMAN.  The  delegate  of  Salvador  has  the  floor,  and  will 
read  an  extract  from  his  report. 

The  delegate  of  Salvador  then  read  an  extract  of  the  report  which 
he  submits  to  the  convention,  in  accordance  with  the  provisions  of  the 
program,  and  which  will  be  found  in  the  Appendix,  page  188. 

DR.  WYMAN.  Mr.  Chairman:  We  have  with  us  this  morning  the 
Secretary  of  the  Bureau  of  American  Republics — the  Acting  Director 
at  the  present  time — who  has  come  from  Washington  to  show  the  inter- 
est of  the  Bureau  of  the  American  Republics  in  the  Convention. 

I  move,  Sir,  that  the  privileges  of  the  floor  be  granted  to  Mr.  Yanes, 
Secretary  of  the  Bureau  of  American  Republics. 

DR.  JOHNSON.  I  second  the  motion. 

DR.  YANES  then  delivered  in  Spanish  the  following  address: 

In  view  of  the  existing  relations  between  the  International  Bureau 
of  the  American  Republics,  which  I  have  the  honor  to  represent,  and 
the  international  sanitary  conventions,  it  is  perfectly  natural  that  this 
Bureau  should  desire  to  be  with  you  here  on  this  important  occasion, 
and  to  that  end  I  have  come  from  Washington,  commissioned  by  said 
Bureau,  as  the  bearer  of  the  cordial  greeting  of  the  Bureau  and  its 
Governing  Board,  who  sincerely  wish  you  Godspeed  and  the  greatest 
success  in  your  humanitarian  work. 

The  Honorable  John  Barrett,  Director  of  the  Bureau,  contemplated 
coming  personally  to  greet  you,  but  inasmuch  as  just  at  this  time  the 
Central  American  Peace  Conference  is  being  held  in  Washington  in 
the  offices  of  the  Bureau,  he  entrusted  to  me  this  highly  appreciated 
honor,  with  the  express  request  that  I  should  personally  represent  him 
and  greet  you  in  his  name. 

This  is  a  gala  day  for  the  International  Bureau  of  the  American 
Republics.  It  is  the  first  time  in  the  history  of  the  Bureau  that 
two  events  of  transcendental  importance  for  Pan-America  are  taking 
place  simultaneously.  There,  in  Washington,  under  the  same  roof  that 
shelters  the  Bureau,  the  Central-American  Peace  Conference,  as  I  said 
before,  is  holding  its  sessions,  a  Conference  brought  about  through  the 
noble,  great,  disinterested  and  friendly  initiative  of  the  two  eminent 
statesmen  who  guide  the  destinies  of  Mexico  and  the  United  States. 
This  friendly  suggestion  was  carefully  accepted  by  our  brethren  of 
Central  America,  full  of  hope  in  the  future,  for  the  purpose  of  seeking 
a  peaceful  settlement  of  theif  differences. 

Here  in  this  beautiful  and  legendary  City  of  Mexico,  the  cradle  and 
home  of  many  illustrious  men,  in  response  to  the  call  of  the  Inter- 
national Sanitary  Bureau,  extended  to  the  Governments  of  the  Inter- 
national Union  through  the  Bureau  of 'the  American  Republics,  the 
representatives  of  the  medical  science,  high-minded  and  brave  war- 
riors that  they  are,  have  assembled  to  again  hold  a  conference  of  learn- 
ing, their  noble  and  sole  ideal  being  the  welfare  of  mankind. 

This  is  the  third  time  that  the  Bureau  of  the  American  Republics 
attends  your  conventions,  and  also  the  third  time  it  has  felt  proud  to 
see  assembled  the  great  scientists  of  Pan-America — from  pole  to  pole — 
united  in  behalf  of  the  Common  good.  Co-laborers  in  a  holy  cause, 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  35 

genuine  representatives  of  the  most  lofty  altruism,  you  come  to  this 
tournament  of  learning  to  teach  the  whole  world  all  you  have  discov- 
ered by  burning  the  midnight  oil,  in  your  long  hours  of  vigil  at  the  bed- 
side of  the  sick,  in  the  solitude  of  your  libraries,  struggling  against 
mystery,  armed  only  with  your  conscience,  in  order  to  avoid  the  evils 
afflicting  mankind,  to  prevent  contagion  and  to  improve  the  conditions 
of  the  poor,  who  are  ever  the  greatest  victims  in  all  great  calamities. 

Not  only  Pan-America,  but  the  whole  world,  has  followed,  step  by 
step,  your  struggles  and  your  triumphs  since  you  met  for  the  second 
time  in  Washington,  and  the  world  hopes  to  learn  what  progress  you 
have  since  made  and  what  plans  you  have  formed  for  -the  future. 
(Applause.) 

THE  CHAIRMAN.  Without  prejudice  to  the  right  of  the  delegate  of 
Ecuador  to  read  the  extract  from  his  report  tomorrow,  we  shall  now 
proceed  to  discuss  the  measures  of  International  Sanitary  Police  relat- 
ing to  yellow  fever. 

I  should  like  to  know  if  any  of  the  delegates  has  any  objections  to 
make.  As  no  one  desires  to  make  any  remarks,  I  will  take  the  liberty 
to  say  a  few  words. 

Gentlemen:  Inasmuch  as  the  object  of  our  meeting  is  to  continue 
to  study  in  detail  all  such  processes  as  may  be  efficiently  employed  in 
behalf  of  mankind,  especially  concerning  the  transmission  of  conta- 
gious and  infectious  diseases,  I  will  now  explain  the  method  we  have 
been  following  in  Mexico  for  many  years. 

Our  sanitary  provisions  do  not  change  measures  that  have  already 
been  accepted.  I  here  and  now  declare  that  I  accept  the  resolutions 
adopted  by  the  Second  International  Sanitary  Convention  concerning 
yellow  fever.  I  make  this  explanation  because  what  I  am  going  to 
say  deviates  somewhat  from  the  practice  recommended  therein;  but 
since  said  practice  is  recommended  so  that  one  nation  may  not  injure 
another,  it  does  not  limit  in  any  sense  the  right  to  make  said  practice 
less  severe  if  it  deems  it  can  better  protect  itself  by  so  doing. 

The  manner  in  which  we  defend  ourselves  against  yellow  fever  is 
based  on  the  resolution  adopted  by  the  Dresden  Convention,  and  by  the 
first  Convention  of  Paris,  which  have  not  been  modified  in  Europe,  as 
Dr.  Guiteras  has  pointed  out. 

The  International  Convention  held  in  Paris  in  1903,  devotes  only  one 
article  to  yellow  fever,  in  which  it  recommends  to  the  countries  where 
the  yellow  fever  stegomya  exists,  that  their  sanitary  provisions  should 
be  in  accordance  therewith,  but  Dr.  Guiteras  has  presented  the  question 
under  a  very  interesting  aspect.  Instead  of  the  Paris  Convention  com- 
ing to  Pan- America  and  advising  them  to  make  their  rules  and  regu- 
lations so  that  they  will  conform  to  the  knowledge  that  medical  science 
now  has  concerning  yellow  fever,  it  is  Dr.  Guiteras  who  now  suggests 
to  the  Paris  Convention  that  it  be  guided  by  such  rules  and  regulations 
as  we  have  adopted,  using  them  as  a  model  in  preparing  their  rules 
and  regulations  to  be  put  in  force  in  their  colonies  where  yellow  fever 
prevails. 

This  interchange  of  views  and  experiences  is  of  unquestioned  utility, 
and  we  see  it  every  day.  The  Convention  of  Paris  advises  us  to  adopt 
certain  measures;  we  thereupon  accept  them,  and  after  having  care- 
fully studied  the  same,  we  return  them  modified  to  said  Convention., 


36  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

The  object  of  this  preamble  is  simply  to  explain  that  what  I  am 
going  to  say  is  not  against  the  resolution  adopted,  but  only  to  state 
what  we  do  in  Mexico. 

We  do  not  make  the  inspection  just  as  prescribed  in  the  Sanitary 
Convention  of  Washington.  Now  the  inspection  of  healthy  passengers 
on  board  of  vessels  consists  in  the  complete  isolation  of  said  persons 
until  six  days  shall  have  elapsed,  while  in  Mexico  we  only  watch  said 
persons. 

In  accordance  with  the  Convention  of  Paris,  the  vigilance  consists 
in  the  fact  that  healthy  persons  on  board  a  vessel  coming  from  a  port 
infected  with  yellow  fever,  may  land  and  be  granted  free  pratique,  but 
they  are,  nevertheless,  watched,  during  the  days  remaining  in  order  to 
complete  the  six  days  of  inspection. 

This  practice,  which  is  the  one  we  observe,  forms  a  part  of  our 
Sanitary  Code.  We  have  no  place  in  which  to  isolate  yellow  fever 
patients,  so  that  when  a  vessel  arrives,  the  health  officers  make  the 
inspection  visit,  and  examine  each  of  the  passengers,  takes  his  tem- 
perature to  determine  whether  or  not  he  has  fever,  and  if  he  has  no 
fever  the  following  distinction  is  made: 

Nothing  is  done  to  persons  who  show  that  they  are  immune  con- 
cerning yellow  fever,  and  those  who  cannot  prove  that  they  are  im- 
mune as  to  said  disease,  are  divided  into  two  classes,  namely:  one 
comprising  those  whose  destination  is  the  Central  Plateau  of  Anahuac, 
2,000  meters  above  sea  level,  where  the  stegomya  does  not  procreate. 
Experiments  have  been  made  to  breed  them,  but  they  have  hardly  been 
able  to  live  two  weeks. 

Therefore,  persons  who  intend  to  go  to  the  Central  Plateau  of  the 
Republic  are  not  neglected,  but  are  taken  to  said  plateau,  being  sure 
that  they  will  not  spread  yellow  fever  even  though  they  are  infected 
with  it. 

The  other  group  consists  of  persons  who  intend  to  remain  at  the 
ports  of  arrival,  or  in  such  places  on  the  coast  where  we  now  know 
that  yellow  fever  has  existed.  Said  persons  are  not  isolated,  but  are 
watched  by  the  authorities  charged  with  the  performance  of  this  duty, 
and  he  does  so  in  the  way  I  indicated  to  you  yesterday.  It  is  the  duty 
of  sanitary  brigades  to  daily  visit  persons  who  are  not  immune,  keeping 
a  special  record  of  those  who  enter  and  leave,  watching  them  for  a 
period  of  five  or  six  days,  that  is  to  say,  until  the  end  of  the  vigilance 
period,  or  until  the  date  they  are  taken  sick.  We  have  followed  this 
method  for  a  long  time  with  excellent  results,  and  consequently,  I  have 
arrived  at  the  following  conclusion:  The  more  severe  the  provisions 
adopted  to  prevent  the  intercommunication  of  people,  the  more  difficult 
it  is  to  obtain  this  result.  To  illustrate  this  fact,  I  shall  avail  myself 
of  the  examples  afforded  by  the  besieged  and  the  besiegers.  In  a 
besieged  city,  the  besiegers  show  as  much  interest  in  preventing  the 
escape  of  the  besieged  as  the  latter  are  interested  in  preventing  the 
entrance  of  the  besiegers.  This  is  the  problem,  and  yet  it  is  seen  that 
the  besieged  go  out,  and  that  the  besiegers  enter.  If  such  intercom- 
munication can  not  be  avoided  in  besieged  cities,  how  could  it  be 
avoided  in  the  case  of  ports  ? 

Some  people  arrive  at  a  port  who  greatly  desire  to  continue  their 
travel  in  order  to  join  their  families,  or  to  continue  their  business, 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  37 

or  guided  by  their  natural  instincts,  desire  to  be  free,  and  such  persons 
have  no  special  reason  for  concealing  their  name,  their  place  of  resi- 
dence or  their  destination.  They  freely  give  us  this  information,  and 
it  is  because  of  this  that  we  have  succeeded  in  discovering  all  the  cases 
in  all  the  places  where  yellow  fever  may  spread.  I  thought  it  was  of 
the  utmost  importance  to  advise  you  of  these  results,  because  I  have 
felt  that  it  might  be  useful  for  you  to  know  what  we  do  here,  and  as 
soon  as  we  have  exterminated  yellow  fever  entirely  these  provisions 
may  be  put  in  practice  generally  in  other  countries,  but  I  repeat,  that 
these  remarks  made  to  you  concerning  the  methods  we  follow,  do  not 
mean  that  we  object  to  the  articles  relating  to  the  matter  of  the  Con- 
vention to  which  I  have  just  referred.  (Applause.) 

DR.  GUITERAS.  In  the  first  place,  I  wish  to  state  that  the  extra- 
ordinary success  recently  obtained  in  Mexico  concerning  yellow  fever 
does  not  seem  to  me  to  be  due  to  the  manner  of  treating  persons 
suspected  of  being  afflicted  with  that  disease  coming  from  abroad, 
that  is  to  say,  that  when  Dr.  Liceaga  explained,  as  he  has  done,  the 
method  employed  in  this  country  in  receiving  passengers  coming  from 
countries  where  yellow  fever  prevails,  the  excellent  results  obtained 
here  during  the  last  two  years  seem  to  confirm  his  statements.  But 
what  I  wish  to  say  is  that  this  way  of  receiving  passengers  has  nothing 
to  do  with  the  brilliant  results  obtained,  or,  in  other  words,  that  it 
seems  to  me  that  the  system  followed  in  Mexico  with  regard  to  passen- 
gers coming  from  countries  where  yellow  fever  prevails  has  not  yet 
been  thoroughly  tried. 

As  a  matter  of  fact,  during  the  last  few  years  Mexico  has  not  been 
exposed  to  the  introduction  of  yellow  fever,  except  in  a  very  remote 
way.  I  will  mention  the  following  example:  There  have  been  very 
few  cases  of  yellow  fever  in  Cuba,  the  disease  having  disappeared  al- 
most simultaneously  in  the  ports  of  Mexico  which  have  communication 
with  the  former  country. 

So  that  what  I  simply  wish  to  state  is  that  I  do  not  believe  this 
process  of  admitting  to  the  country,  without  previous  inspection  in  a 
suitable  place,  the  persons  infected  with  yellow  fever,  has  been  prop- 
erly tried. 

I  fear  if  this  country  were  exposed  to  a  serious  invasion  of  the 
disease,  for  instance  to  great  epidemics  on  the  Gulf  of  Mexico  and  on 
the  south  coast  of  the  United  States,  I  fear,  I  repeat,  that  the  results 
obtained  would  not  be  so  satisfactory.  It  seems  to  me  that  there 
is  some  danger  in  following  this  system. 

On  the  other  hand,  it  should  be  borne  in  mind  that  in  the  Mexican 
Republic,  like  other  countries  exposed  to  the  introduction  of  yellow 
fever,  there  is  a  large  extent  of  territory  to  which  the  great  current 
of  immigration  flows,  and  where,  as  Dr.  Liceaga  has  informed  us,  yel- 
low fever  can  not  spread,  I  believe,  therefore,  that  I  am  right  when 
I  say  that  the  greater  part  of  the  immigrants  who  enter  the  Mexican 
Republic  go  to  that  section  of  the  Republic,  that  is  to  say,  to  the 
Central  Plateau,  where  it  is  impossible  for  yellow  fever  to  spread 

On  the  other  hand  there  are  countries  like  Cuba,  for  instance,  where 
there  is  not  a  single  nook,  where  yellow  fever  does  not  prevail,  and 
where  the  stegomya  does  not  exist. 

So  that,  I  still  believe  that  the  process  explained  by  Dr.  Liceaga 


38  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

would,  in  the  case  of  a  severe  epidemic,  it  seems  to  me,  be  a  failure. 
At  least  I  fear  it  would  be  so. 

THE  CHAIRMAN.  I  beg  to  make  an  explanation  showing  exactly  the 
idea  I  meant  to  convey. 

Dr.  Guiteras  believes  that  I  intended  to  say  that  one  of  the  elements 
for  preventing  the  spread  of  yellow  fever,  is  the  manner  in  which  we 
rceive  people  from  abroad.  Now  I  simply  state  that,  although  we 
have  not  the  restrictions  in  force  in  Cuba,  yellow  fever  has  not  been 
introduced  into  our  country  by  means  of  the  system  we  employ.  As 
to  his  second  contention,  I  do  not  pretend  that  said  system  should  be 
accepted  in  countries  different  from  ours,  but  I  simply  stated  what 
we  do. 

It  is  true  that  a  great  number  of  people  from  abroad  go  to  the 
Central  Plateau,  but  it  is  also  true  that  many  persons  remain  at  differ- 
ent places  on  the  coast,  to  such  an  extent  that  all  the  work  done  on 
the  plantations  in  those  sections  is  done  by  immigrants,  which  places 
are  most  exposed  to  yellow  fever.  I  should  add  that  in  Veracruz  alone 
there  are  10,000  persons  who  are  not  immune. 

DR.  WYMAN.  I  feel  that  I  should  not  allow  this  occasion  to  go  by 
without  saying  a  few  words  apropos  of  the  subject  under  discussion. 
The  discussion  illustrates  the  fact  that  while  general  principles  will 
hold  good  between  countries,  here  are  different  conditions  in  each 
country  which  force  themselves  upon  the  sanitary  authorities  of  the 
respective  countries.  The  system  adopted  by  Mexico  is  admirable, 
and  is  effective  with  regard  to  Mexico,  and  so  far  as  its  underlying 
principles  are  concerned,  the  same  practice  really  prevails  in  the 
United  States. 

For  example,  people  coming  from  foreign  countries  infected  with 
yellow  fever  are  subject  to  no  restriction  or  restraint;  to  no  detention, 
at  points  north  of  the  southern  boundary  of  Maryland,  that  is  to  say 
in  non-infectable  territory.  Just  as  you  allow  anybody  from  a  foreign 
infected  territory  to  land  at  Veracruz  and  come  direct  to  Mexico,  where 
the  state  of  yellow  fever  does  not  exist,  so  would  we  allow  anybody  to 
come  to  Boston  and  pay  no  attention  to  them,  even  if  there  were  a 
yellow  fever  epidemic  in  Havana  or  in  Central  American  Republics. 

If  a  ship  arrived,  we  would  do  no  more  than  inspect  that  ship  and 
remove  anybody  that  happened  to  be  sick.  But  there  is  no  detention. 
We  would  inspect  the  ship,  inasmuch  as  the  ship  might  afterwards  go 
down  to  points  on  the  southern  coast  which  are  in  the  infectable 
territory. 

So  these  principles  are  practically  the  same,  but  in  their  application 
we  have  to  give  consideration  to  the  special  conditions  existing  in  dif- 
ferent parts  of  the  country. 

Another  thing:  In  Mexico  you  have  on  the  Atlantic  coast  but  two 
or  three  important  seaports.  We  are  obliged  by  our  law  to  have  uni- 
formity of  quarantine  regulations  otnerwise  it  would  not  be  fair  to  all, 
and  we  have  in  the  United  States  a  large  number  of  ports  in  the  infecta- 
ble territory,  and  it  is  absolutely  necessary  for  us  to  administer  our 
quarantine  regulations  just  as  we  do ;  but  where  feasible,  as  in  the 
north,  or  in  ports  north  of  the  southern  boundary  of  Maryland,  there 
is  no  particular  restriction  or  restraint,  excepting  at  the  port  of  New 
York,  where  persons  still  in  the  incubative  period  of  yellow  fever,  if 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  39 

they  have  been  attacked  with  that  disease  before  leaving  an  infected 
foreign  port,  might  pass  right  through  New  York  and  take  a  railroad 
train  to  the  South  and  land  in  infectable  territory  before  the  period  of 
incubation  had  passed,  and  thus  develop  the  disease  within  infectable 
territory. 

Therefore,  while  there  is  apparently  some  difference  in  our  view- 
point, I  think  that  really  we  are  all  acting  upon  the  same  principles 
somewhat  differently  applied,  according  to  the  circumstances. 

DR.  GONQALVEZ  CRUZ.  In  order  to  show  the  value  of  sanitary  vigil- 
ance in  the  prophylaxis  of  yellow  fever,  I  will  for  a  moment  call  your 
attention  to  the  city  of  Rio  de  Janeiro,  in  which  there  were  places 
entirely  free  from  yellow  fever,  and  others  where  it  did  prevail.  Even 
persons  who  were  immune,  residing  in  the  foci  of  infection,  were 
submitted  to  daily  inspection  as  far  as  possible.  This  system  was  of 
undoubted  advantage,  and  by  means  of  it  the  spread  of  the  disease  was 
prevented,  but  it  was  necessary  to  immediately  isolate  all  yellow  fever 
patients  in  order  to  prevent  infection  by  mosquitoes  which  exist  in 
the  city. 

THE  CHAIRMAN.  If  there  are  no  other  remarks  the  meeting  will 
adjourn. 

I  beg  to  remind  the  delegates  that  today  at  3  P.  M.  they  will  be 
received  by  the  President  of  the  Republic.  I  would  request  you  to  be 
there  at  that  hour,  because  the  President  will  be  at  the  Palace  at  that 
time,  and  if  he  should  not  be  there  it  will  not  be  our  fault. 

After  that  we  will  take  an  automobile  ride,  and  then  will  take  tea 
at  the  Chapultepec  Cafe — a  tea  which  is  given  in  honor  of  the  delegates 
and  to  which  the  ladies  are  also  invited. 

I  beg  to  remind  the  Secretary  that  all  persons  desiring  that  their 
reports  be  inserted  in  the  minutes,  must  furnish  extracts  of  the  same 
at  the  end  of  the  session. 

I  now  beg  the  delegates  to  kindly  accompany  me  on  a  visit  to  the 
Post-Office  Department. 

The  session  adjourned. 


4O  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 


THIRD  DAY,  WEDNESDAY,  DECEMBER  4. 
Morning  Session. 

The  meeting  was  called  to  order  by  the  Chairman,  Dr.  Liceaga,  at 
9  a.  m.,  the  following  members  being  present:  Doctors:  Gongalves 
Cruz,  Payan,  Roberts,  Guiteras,  Soza,  Esteves,  Wyman,  Ezdorf, 
Straub,  Gatewood,  Rhett-Goode,  Johnson,  Ortega,  Azurdia,  Lazo  Ar- 
riaga,  Mendizabal,  Gonzalez,  and  Secretary  Ulloa. 

The  minutes  of  the  second  and  third  days  being  open  to  discussion, 
Dr.  Guiteras,  representative  of  Cuba,  was  granted  the  floor,  and  said 
that  the  remarks  he  made  in  the  previous  session  had  been  delivered  by 
him  in  writing  in  a  more  comprehensive  form  than  they  appeared  in 
the  minutes  just  read. 

Secretary  Ulloa  stated  that  the  remarks  made  by  the  delegates 
would  appear  in  full  in  the  minutes  which  would  be  published  at  the 
close  of  the  Convention,  and  therein  will  be  found  in  full  the  remarks 
made  by  the  representative  of  Cuba. 

The  representative  of  Brazil  made  the  following  explanation: 

The  isolation  of  yellow  fever  patients  in  Rio  de  Janeiro  is  very 
rigorous,  and  medical  vigilance  constitutes  an  additional  measure,  and 
does  not  substitute  the  isolation  as  stated  in  the  minutes.  The  minutes 
were  approved. 

The  Chairman  granted  the  floor  to  Dr.  Esteves,  of  Ecuador,  to  read 
his  report,  which  was  pending. 

DR.  ESTEVES.  Before  reading  my  report,  permit  me  to  state  that  the 
bubonic  plague,  trachoma  and  beri-beri  are  unknown  in  Ecuador;  we 
have  yellow  fever  and  malaria,  and  sometimes  we  have  smallpox. 
Yellow  fever  is  endemic  in  the  country,  but  in  certain  seasons  it  be- 
comes epidemic.  Malaria  occurs  in  different  forms,  and  with  regard 
to  smallpox,  it  generally  occurs  only  among  persons  who  have  not 
been  vaccinated. 

He  then  read  the  report  that  appears  on  page  169  of  Appendix. 

THE  CHAIRMAN.  The  discussion  which  was  to  take  place  this 
morning  relates  to  such  measures  of  international  police  against  yel- 
low fever  as  are  proposed  in  the  papers  or  reports  of  the  delegates, 
but  since  this  was  done  in  yesterday's  session,  the  discussion  on  malaria 
belongs  to  this"  session,  apropos  of  the  same  papers  or  reports. 

Dr.  Wyman  desires  to  call  the  attention  of  the  delegates  to  a  paper 
on  measures  of  international  prophylaxis  in  order  that  it  may  be  re- 
ferred to  the  Advisory  Committee  to  be  studied  and  acted  upon.  Dr. 
Wyman  has  the  floor. 

DR.  WYMAN  read  the  following  propositions : 

First.  International  Conference  on  health  matters  have  heretofore  con- 
sidered only  the  management  of  epidemic  diseases  in  their  progress  from  one 
nation  to  another. 

Second.  These  diseases  arc  simply  the  result  of  unhygienic  conditions  in  the 
several  countries. 


Photo  Harris  and  Fining 

DR.  EDUARDO  LICEAGA,  OF  MEXICO, 

President    of    the    Third    International     Sanitary    Convention     of    American 

Republics. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  41 

Third.  These  unhygienic  conditions  are  local,  and  the  responsibility  on  their 
account  lies  with  municipal  or  State  authorities. 

Fourth.  The  national  governments  therefore  are  required  to  deal  with  condi- 
tions due  to  faults  of  the  States  and  municipalities. 

Fifth.  In  the  measures  to  prevent  the  spread  of  disease  from  one  country  to 
another,  plainly  the  duty  of  national  governments,  the  latter  are  theretofore 
dealing  only  with  the  effects  and  not  with  the  cause;  they  are  dealing  with  the 
symptoms  rather  than  with  the  causative  conditions. 

Sixth.  Therefore,  notwithstanding  that  the  fons  et  origo  of  disease  is  ordina- 
rily considered  as  within  the  legal  jurisdiction  and  administration  (police  power) 
of  the  States  and  municipalities,  the  national  governments  must  find  some  means 
of  exercising  effective  influence  in  these  local  conditions  which  produce  disas- 
trous effects  that  quickly  become  the  care  and  responsibility  of  the  nation. 

Seventh.  Quarantine  and  quarantinable  diseases  which  heretofore  have  been 
the  subjects  of  international  conventions  and  agreements  should  now  be  put  to 
one  side  as  having  been  duly  considered  and  acted  upon ;  and  an  advance  should 
be  made  in  international  deliberations  by  the  consideration  of  hygiene  and  sanita- 
tion. In  other  words,  the  deliberations  of  international  sanitarians  should  be 
transferred  from  ships  to  the  shore. 

Eighth.  In  considering  the  possibility  of  an  international  agreement  for  a 
more  direct  and  effective  influence  of  the  national  governments  in  local  sanita- 
tion and  hygiene  it  will  be  more  practicable  to  limit  such  agreement  to'  seaport 
cities  and  towns,  since  these  are  the  points  of  contact  between  nations. 

Ninth.  In  the  effort  to  perfect  the  sanitary  and  hygienic  condition  of  seaports 
we  find  an  international  commercial  justification  therefore  in  the  resultant  elim- 
ination of  yellow  fever.  There  is  another  all  important  disease — tuberculosis — 
for  whose  elimination  the  commercial  reason  does  not  apply,  but  against  which 
the  whole  civilized  world  is  making  warfare.  This  disease,  on  account  of  its 
universality  and  contagiousness,  is  well  worthy  of  consideration  in  international 
agreements,  irrespective  of  the  commercial  relations  between  nations. 

Tenth.  In  the  sanitary  and  hygiene  measures  necessary  to  eliminate  the  two 
above-mentioned  diseases — yellow  fever  and  tuberculosis — are  embraced  the 
sanitary  and  hygienic  measures  (with  the  exception  of  minor  details)  necessary 
to  overcome  all  the  greater  epidemic  and  the  domestic  contagious  diseases. 

Eleventh.  The  more  specific  the  objects  of  any  agreement,  the  more  direct 
and  effective  will  be  the  efforts  to  enforce  it.  Therefore  there  is  recommended 
an  international  agreement  for  national  effort  in  sanitary  and  hygienic  measures 
necessary  to  eliminate  yellow  fever  and  tuberculosis. 

From  the  foregoing  propositions  it  appears  necessary  that  the  central 
or  national  government  of  each  republic  should  give  greater  attention 
to  local  sanitary  measures.  It  is  admitted  that  the  activity  of  the 
national  government  in  local  sanitation  is  more  difficult  in  some  of  the 
republics  than  in  others,  yet  it  is  believed  that  in  all  much  can  be 
accomplished  beyond  the  present  activities  and  beyond  the  limitations 
which  now  seem  to  be  acknowledged. 

The  proposed  limitation  of  an  international  agreement  to  seaports  is 
defended  by  the  following  considerations : 

First.  Seaports  have  a  more  direct  influence  in  conveying  disease 
from  one  country  to  another  than  interior  ports. 

Second.  The  good  effect  of  sanitation  in  seaports  will  be  so  obvious 
that  interior  cities  will  take  note  thereof  and  profit  by  the  example. 

Third.  By  making  the  agreement  relate  to  seaports  only  the  scope 
thereof  is  limited  and  defined  and  the  plan,  therefore,  more  practicable. 

It  may  be  remarked  that  in  many  of  our  larger  seaport  cities,  such  as 
New  Orleans,  Rio  de  Janeiro,  Veracruz,  and  others,  sanitary  improve- 
ments of  a  broad  character,  such  as  improved  water  supplies,  sewerage, 
drainage  and  paving,  are  already  under  way. 

In  quite  a  number  of  the  smaller  ports,  particularly  in  some  of  the 
Central  and  South  American  republics,  there  has  been  manifested  dur- 


42  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

ing  the  past  four  years  an  awakening  to  the  need  of  sanitation  and 
actual  work  has  been  done.  But  in  all  our  larger  ports,  no  matter  how 
extensive  the  improvements,  much  remains  to  be  done  to  bring  local 
sanitation  and  hygiene  up  to  the  required  standard,  and  in  numerous 
smaller  ports  in  all  of  the  republics  both  on  the  Atlantic  and  Pacific 
coasts,  sanitation  is  at  the  present  time  outrageously  neglected.  These 
smaller  seaport  towns  and  cities  are  potent  factors  in  the  breeding  and 
dissemination  of  disease,  and  yet  their  proper  sanitation  would  involve 
comparatively  moderate  expense. 

In  considering  local  sanitary  measures  it  is  worthy  of  note  that 
measures  to  eradicate  and  prevent  two  of  the  most  important  diseases 
will  be  sufficient  practically  for  the  eradication  of  other  communicable 
diseases. 

Sanitation  for  tuberculosis  requires  sufficiency  of  air  and  sunlight 
in  domiciles,  good  water  supply,  drainage  and  sewerage,  while  the  sani- 
tation for  yellow  fever,  demanding  the  removal  of  collections  of  water 
to  prevent  the  breeding  of  mosquitoes,  involves  general  hygienic  condi- 
tions of  premises,  so  that  with  the  cleanliness  in  and  around  the  domicile 
and  assurance  of  the  proper  environments  of  man,  conditions  are  pro- 
duced favorable  to  the  elimination  of  all  disease. 

The  whole  civilized  world  is  fighting  against  tuberculosis,  the  great 
white  plague,  which  causes  at  least  one  in  seven  of  all  deaths,  and  any 
international  agreements  for  its  suppression  will  redound  to  the  honor 
of  every  nation  concerned  therein.  As  to  yellow  fever,  a  disease  which 
is  the  curse  of  the  Western  Hemisphere,  conjoint  action  of  the  republics 
is  necessary  for  its  elimination. 

It  is,  therefore,  respectfully  recommended  that  the  central  or  national 
administration  of  each  republic  will  use  its  utmost  endeavors  to 
institute  and  enforce  locally  in  its  several  seaports  all  the  sanitary 
measures  destructive,  constructive  and  administrative,  which  are  neces- 
sary to  eliminate  tuberculosis  and  yellow  fever. 

In  addition  to  the  reasons  given  above  showing  the  necessity  for  such 
an  international  agreement,  there  are  others  which,  though  less  urgent, 
should  nevertheless  lend  encouragement  thereto.  It  gives  opportunity 
for  the  countries  represented  in  the  Rio  Conference  to  set  an  example 
which  may  be  utilized  in  the  coming  Hague  Conference,  at  which  it  is 
understood  all  the  republics  of  the  Western  Hemisphere  will  be 
represented. 

In  the  present  relations  of  nations  with  one  another  there  are  two 
facts  which  seem  strangely  at  variance :  First,  the  regularly  increasing 
naval  and  military  armaments;  second,  the  rapidly  growing  sentiment 
for  universal  peace  and  disarmament. 

Few  will  deny  that  universal  peace  is  a  desideratum.  It  is  said  that 
it  is  the  purpose  of  the  Interparliamentary  Union  to  make  of  the  Hague 
Conference  a  permanent  body  composed  of  two  houses — an  upper  house 
representing  the  executives  of  the  world,  and  a  lower  house  composed 
of  the  members  of  the  highest  legislative  bodies  of  the  powers  of 
the  earth. 

Even  if  such  a  body  is  formed  it  would  be  marvelous  if  of  itself  it 
should  be  able  to  bring  about  a  disarmament  of  the  nations.  Increase 
in  armaments  provides  increase  of  employment  of  all  kinds — manual, 
professional,  and  administrative,  and  furnishes  an  outlet  for  the  energy 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  43 

of  a  nation.  It  is  worth  considering  whether  a  diversion  of  this  energy 
is  not  more  practicable  than  its  abrupt  termination. 

A  celebrated  manufacturer  in  the  United  States,  with  a  plant  cover- 
ing several  acres,  was  much  annoyed  by  the  mischievous  activities  of 
a  large  number  of  boys  in  the  neighborhood  who  trespassed  upon  the 
property,  maliciously  injuring  the  same.  Instead  of  arresting  them  and 
causing  their  punishment,  he  diverted  their  energies  by  purchasing  land 
immediately  around  his  plant  and  employing  them  in  the  development 
of  lawns  and  gardens,  thus  adding  to  the  attractiveness  and  utility 
of  his  possessions  and  transforming  his  annoying  neighbors  into  agents 
of  help. 

This  may  be  a  homely  illustration,  but  surely  an  international 
hygienic  agreement  which  would  demand  physical  operations  of  great 
scope,  and  professional  and  administrative  energies  of  the  highest  char- 
acter would  be  more  effective  by  diverting  such  energies  from  naval  and 
military  establishments  than  would  be  an  effort  to  discontinue  or 
abandon  the  military  and  naval  armaments. 

The  same  principles  apply  whether  reference  is  made  to  disarmament, 
arbitration,  or  the  world-wide  movement  for  peace. 

An  international  agreement  for  sanitation,  with  the  avowed  purpose 
of  eliminating  communicable  diseases,  will  furnish  a  plane  upon 
which  nations  may  meet;  and  an  object  for  attack  against  which  all 
nations  may  combine  without  fear  of  international  complications. 

THE  CHAIRMAN.  As  I  stated  before,  the  propositions  made  by  Doc- 
tor Wyman  will  be  referred  to  the  Advisory  Committee. 

The  representatives  of  Colombia  have  some  other  proposition  to  sub- 
mit to  the  delegates  before  commencing  the  discussion  on  malaria. 

The  representative  of  Colombia  has  the  floor. 

DR.  GUTIERREZ.  I  submit  the  following  proposition  to  the  Advisory 
Committee : 

Whereas,  it  is  a  scientific  fact  that  vaccination  is  the  best  prophylactic  means 
of  avoiding  smallpox. 

Whereas,  many  civilized  nations  have  enacted  laws  making  vaccination  com- 
pulsory; and 

Whereas,  the  conditions  prevailing  in  many  of  the  nations  we  represent,  favor 
the  development  and  spread  of  epidemic  smallpox. 

The  Convention  resolves,  To  make  known  to  the  Governments  represented  in 
this  Convention  the  benefit  which  each  nation  would  derive  by  making  vaccination 
compulsory. 

In  order  to  render  their  action  still  more  efficient,  the  advantage  of  cultivating 
the  vaccine  virus  in  each  country  and  the  distributing  of  it  gratis  among  the  in- 
habitants, is  recommended. 

As  a  result  of  the  foregoing,  to  open  a  vaccination  registry  in  the  cities,  towns 
and  villages,  in  order  that  the  local  and  duly  qualified  physicians  as  well  as  those 
who  are  members  of  the  Board  of  Health,  may  issue  the  certificates  required  for 
entrance  into  municipal  and  national  schools  and  institutes,  and  such  other 
establishments  as  may  require  them. 

The  above  was  referred  to  the  Advisory  Committee. 

DR.  AZURDIA,  representative  of  Guatemala.  The  resolution  I  have 
the  honor  to  present,  I  think  should  be  referred  to  the  Advisory  Com- 
mittee. 

I  believe  that  nations  as  such  should  make  their  sanitary  police 
exclusively  defensive  in  behalf  of  friendly  nations  with  which  they 
maintain  commercial  relations,  in  such  way  that  I  entirely  agree  with 
the  opinion  already  expressed  by  Dr.  Liceaga  concerning  the  fact  that 


44  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

the  origin  of  contagious  diseases  should  be  combatted  and  that  we 
should  never  ask  friendly  nations  to  do  so. 

In  view  of  the  above,  in  the  case  of  malaria,  and  in  connection  with 
all  I  have  had  occasion  to  observe  in  the  countries  afflicted  by  such 
disease,  it  seems  to  me  that  it  would  be  advisable  for  the  Convention 
to  adopt  the  following  resolutions,  which  I  respectfully  propose: 

RESOLUTIONS  AGAINST  MALARIA. 

Whereas,  notwithstanding  the  general  method  adopted  for  combating  malaria 
by  the  destruction  of  mosquitoes,  the  application  of  petroleum  to  stagnant 
waters,  etc.,  the  efforts  made  by  some  countries  have  not  met  with  success. 

Whereas,  with  the  assistance  of  the  Government  malaria  could  be  effectively 
prevented  instead  of  having  to  be  cured. 

It  is  recommended: 

1.  That  quinine  salts  be  declared  free  of  import  duties  in  all  countries  afflicted 
•with  malaria. 

2.  That  industries  engaged  in  the  manufacture  of  quinine  salts  shall  be  fully 
protected  by  the  State. 

3.  That  fine  mesh  wire  gauze  used  for  mosquito  nets,  the  protection  to  dwell- 
ings, offices,  halls.,  etc.,  in  order  to  prevent  the  admission  of  mosquitoes,  be  also 
declared  free  of  import  duties. 

4.  That  it  shall  be  the  duty  of  the  Permanent  International  Sanitary  Bureau 
to  recommend  the  publication,  in  extenso,  of  the  best  treaty  or  work,  in  which 
are  compiled  in  a  brief,  simple  and  practical  form,  readily  understood  by  the 
people,  the  aphorisms  constituting  the  bases  of  what  may  hencefoith  be  called 
the  struggle  against  malaria,  and  said  Bureau  should  make  a  propaganda  con- 
cerning this  movement,  and  suggest  such  prize  as  the  author  of  the  best  work  on 
the  subject  may  be  entitled  to. 

THE  CHAIRMAN.  I  suggest  that,  like  the  former  ones,  this  proposi- 
tion, be  referred  to  the  Advisory  Committee.  Dr.  Mendizabal  has  the 
floor. 

DR.  MENDIZABAL.  Mr.  Chairman  and  delegates:  It  is  surprising  to 
me  that  in  this  defense  which  the  nations  have  commenced  by  mutual 
agreement  to  protect  themselves  against  certain  diseases,  they  have 
never  taken  into  consideration  others  which  cause  as  much  or  greater 
ravages  than  those  we  are  now  discussing.  I  refer,  gentlemen,  to 
syphilis  and  venereal  diseases,  which  are  really  formidable.  It  seems 
to  me  that  we  ought  to  devise  the  means  of  protecting  the  people 
against  these  diseases,  and  of  avoiding  the  spreading  of  the  same. 

Heretofore  nothing  has  been  done  along  these  lines,  and  no  meas- 
ures have  been  taken  against  those  afflicted  with  such  terrible  diseases. 
For  instance,  a  woman  afflicted  with  syphilis  lands  at  one  of  our  ports, 
and  spreads  the  disease  in  an  indefinite  manner;  and  we  all  know  the 
baleful  influence  which  this  terrible  disease  exercises  over  the  whole 
human  race.  Now  that  we  have  such  simple  means  of  accurately 
diagnosing  said  disease,  since  we  have  advanced  beyond  the  bounds 
of  hypothesis,  why  not  adopt  a  resolution  which  would  exterminate 
this  disease?  Why  should  we  not  defend  each  other  against  rjch  a 
disease,  which,  as  I  said  before,  degrades  the  human  race,  and  is  a 
germ  which  entirely  ruins  the  human  organism? 

Every  day  we  treat  patients  with  heart  disease,  disease  of  the  liver, 
and  other  diseases  known  to  the  delegates  which  have  no  other  origin 
but  venereal  or  syphilitic  diseases,  it  being  very  noticeable  above  all, 
how  they  are  inherited  by  children.  A  visit  to  a  hospital  will  show 
•many  diseases  which  have  been  contracted  by  venereal  infection. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  45 

Therefore,  I  would  suggest  that  we  discuss  this  matter  which,  as  I 
said  before,  I  consider  of  the  utmost  importance. 

THE  CHAIRMAN.  What  Dr.  Mendizabal  has  just  said  is  very  im- 
portant, but  as  this  point  is  not,  unfortunately,  comprised  in  the  pro- 
gram, and  we  have  to  confine  ourselves  to  the  latter,  I  would  request 
him  to  make  his  proposition  in  writing  in  order  that  it  may  be  one  of 
the  subjects  of  the  next  Convention,  since  this  matter  could  not  be 
decided  in  the  short  time  we  have  at  our  disposal. 

DR.  GUITERAS.  If  the  Chair  allows  me,  I  wish  to  present  a  resolu- 
tion on  malaria. 

THE  CHAIRMAN.  I  beg  to  make  a  remark. x  If  we  are  going  to  open 
a  discussion  on  malaria,  it  would  be  preferable  that  the  proposition 
should  come  after  the  debate. 

DR.  GUITERAS.  I  did  not  ask  the  floor  in  order  to  discuss,  but  to 
present  a  complete  proposition  which  I  desired  to  add  to  the  Wash- 
ington Convention,  but  it  seems  to  me  better  to  present  the  same  after 
the  debate  on  the  point  indicated  by  Dr.  Liceaga. 

DR.  LAZO-ARRIAGA.  Mr.  Chairman,  I  desire  to  add  something  to  the 
proposition  presented  by  Dr.  Azurdia,  and  in  this  connection  I  would 
request  the  Chair  to  allow  me  to  read  it. 

THE  CHAIRMAN.  If  what  Dr.  Lazo-Arriaga  is  going  to  propose  re- 
lates to  the  proposition  made  by  Dr.  Azurdia,  he  has  the  floor. 

DR.  LAZO-ARRIAGA.  Gentlemen:  Dr.  Azurdia,  of  Guatemala,  pre- 
sents to  this  Congress  some  propositions  relating  to  the  means  which 
should  be  employed  in  order  to  avoid  or  decrease  the  ravages  of 
malaria. 

Agreeing  entirely  with  the  views  of  my  distinguished  colleague,  it 
seems  to  me  that  there  should  be  added  thereto  a  recommendation  to 
the  end  that  periodical  lectures  be  given,  in  the  school,  on  the  easy 
means  which  science  furnishes  to  all  the  inhabitants  of  the  tropics  in 
order  to  avoid  malaria. 

THE  CHAIRMAN.  The  proposition  of  Dr.  Lazo-Arriaga  is  referred  to 
the  Committee  on  Malaria. 

DR.  GUITERAS.  In  my  opinion  the  concrete  propositions  should  be 
submitted  to  this  Convention  after  the  point  on  malaria  shall  have  been 
discussed.  It  seems  that  Dr.  Liceaga  is  willing  to  discuss  malaria, 
and  it  also  seems  to  me  that  he  affords  us  the  opportunity  for  present- 
ing new  propositions.  For  this  reason  I  would  like  to  hear  this  dis- 
cussion in  order  to  present  my  concrete  propositions  afterwards. 

THE  CHAIRMAN.  In  view  of  the  kind  suggestion  just  made  by  Dr.. 
Guiteras,  I  beg  to  open  the  question  to  discussion,  not  that  I  entertain 
any  doubt  of  its  being  known  by  the  delegates,  but  because  it  is  neces- 
sary to  fix  the  terms  of  the  debate.  Although  what  I  am  going  to  read 
may  be  known  to  you,  yet  it  is  necessary  to  read  it  in  order  to  carry- 
on  the  debate  in  the  proper  way. 

Dr.  Liceaga  then  read  the  report  on  malaria,  which  appears  in  the 
Appendix,  page  181. 

DR.  GUITERAS.  I  have  heard  with  great  satisfaction  that  Dr.  Liceaga. 
proposes  to  devote  all  his  energies,  as  well  as  all  the  personnel  that  at 
present  is  combatting  yellow  fever,  to  likewise  attack  malaria,  as  soon 
as  the  other  disease  is  entirely  banished,  and  there  is  no  doubt  that 
the  result  will  be  just  as  brilliant  as  have  been  the  results  obtained  con- 


46  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

earning  yellow  fever.    The  success  obtained  against  this  latter  disease, 
predicts  a  victory  with  regard  to  malaria. 

But  even  before  we  reach  that  moment,  it  may  be  affirmed  that  the 
campaign  which  is  being  waged  against  yellow  fever  is  already  indi- 
rectly exercising  its  influence  against  malaria. 

The  campaign  we  have  waged  in  Cuba  against  yellow  fever,  has 
wonderfully  decreased  the  number  of  deaths  caused  by  malaria.  The 
exact  figures  may  be  seen  in  the  report  presented  by  my  colleague. 

But  there  is  another  point  of  view  to  which  Dr.  Liceaga  has  not  re- 
ferred in  his  admirable  report.  I  refer  to  the  decisive  influence  which 
quarantine  may  have  had  against  malaria. 

It  has  happened  in  Cuba  that  the  number  of  immigrants  afflicted 
with  fever  coming  from  ports  infected  with  yellow  fever,  has  been 
greater  in  the  case  of  malaria  than  in  that  of  yellow  fever.  So  that 
of  the  suspicious  cases  which  our  Marine  Sanitary  Board  sends  to  Las 
Animas  Hospital,  a  great  number  is  infected  with  malaria.  These 
patients  remain  at  the  Hospital  until  they  are  cured,  and  I  would  add 
that  in  this  manner  the  number  of  patients  which  enter  in  the  territory 
of  the  Republic  has  been  considerably  reduced..  Based  on  this  experi- 
ence, I  am  going  to  make  a  motion  to  the  Convention. 

Dr.  Johnson  proposed  that  the  name  "Malarial  Fever"  be  substituted 
for  "Anopheles  fever/' 

DR.  MENDIZABAL.  Gentlemen:  I  will  commence  by  congratulating 
Dr.  Liceaga  for  having  presented  to  us,  with  the  clearness  of  a 
catechism  and  with  the  scope  of  a  hippocratic  aphorism,  the  doctrine 
of  the  campaign  against  malaria.  I  have  always  been  concerned  with 
the  question  of  the  transmission  of  this  disease,  but  the  places  where 
it  has  prevailed  have  concerned  me  much  more.  I  have  practiced  my 
profession  for  many  years  in  the  centers  of  malaria  where  there  were 
from  ten  to  twelve  cases  daily  of  malignant  fevers,  which  used  to  kill 
the  patients  in  24  hours,  and  which  did  not  attack  strong  persons,  even 
though  quinine  was  not  used.  On  the  works  of  the  Mexican  railroad, 
the  first  to  contract  malaria  were  the  workingmen  who  made  the  large 
excavations,  and  who  generally  came  from  the  central  plateau,  but  those 
who  lived  in  accordance  with  the  rules  of  hygiene  did  not  need  to  use 
quinine.  This  disease  did  not  spread  among  my  colleagues  and  em- 
ployees of  certain  rank,  owing  to  the  fact  that  we  observed  the  rules 
of  hygiene.  Dr.  Guiteras  suggested  that  by  establishing  quarantine 
against  patients,  the  spreading  of  the  disease  could  be  avoided.  It 
seems  to  me  that  this  would  be  an  easy  thing  on  sea,  but  on  land  it 
would  be  impossible  because  mercantile  transactions  would  thus  be 
interrupted,  and,  therefore,  this  proposition,  which  is  easy  in  theory, 
would  become  impracticable. 

I  believe  that  lectures,  even  to  very  young  people,  would  give  better 
results  and  be  more  practicable,  because  in  this  way  men  are  taught 
from  childhood  how  to  guard  themselves  against  this  disease,  that  is 
to  say,  by  means  of  nourishing  food,  clean  clothes,  etc. — a  training 
which  can  only  be  had  from  the  time  of  school  days.  I  would,  there- 
fore, prefer  that  the  necessity  of  hygiene  be  clearly  demonstrated,  as 
well  as  the  necessity  of  rendering  the  locality  immune  by  sterilization,  a 
result  which  cannot  be  obtained  except  by  hygiene.  Therefore,  I 
understand  that  the  prophylaxis  of  this  disease  should  be  commenced 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  47 

with  a  campaign  in  the  schools  in  order  to  obtain  the  best  results. 
We  have  an  example  which  we  should  bear  in  mind :  the  great  Japanese 
army  has  been  kept  healthy  in  the  midst  of  terrible  struggles  which  it 
was  able  to  withstand  because  of  hygiene,  and  without  recurring  to 
other  means.  With  regard  to  the  changing  of  the  name  of  the  disease, 
I  do  not  agree  with  the  opinion  of  Dr.  Johnson,  because  it  is  very 
likely  that  at  any  time  it  may  be  said  that  anopheles  does  not  produce 
the  disease,  and  another  kind  of  mosquito  is  already  said  to  produce 
the  disease.  Therefore,  I  would  continue  to  call  the  disease  "Malaria" 
by  which  it  is  universally  known,  and  by  this  name  people  generally 
will  know  how  to  protect  themselves  against  the  disease. 

THE  SECRETARY.  The  present  discussion  is  very  interesting,  and  in 
my  opinion  is  the  most  important  one  that  we  have  to  consider,  inas- 
much as  malaria,  in  its  different  forms,  is  the  greatest  enemy  of  the 
inhabitants  of  this  Continent.  Dr.  Liceaga  has  presented  us  a  work 
on  this  subject  which  will  serve  us  as  a  guide  in  our  discussions, 
and  the  remarks  made  by  Doctors  Lazo-Arriaga  and  Azurdia  are 
no  less  learned.  Although  I  do  not  entirely  agree  with  the  views 
of  Dr.  Mendizabal,  I  beg  to  make  the  following  remark :  It  seemed  to 
me  that  Dr.  Guiteras  did  not  propose  that  quarantine  measures  should 
be  taken  against  malaria,  but  that  he  referred  to  the  quarantine  that 
was  indirectly  established  against  malaria  when  it  was  established 
against  yellow  fever. 

In  regard  to  the  suggestion  of  Dr.  Johnson,  who  proposed  that  the 
name  of  the  disease  be  changed,  I  would  add  to  his  proposition  the 
word  "MOSQUITO/'  because  the  people  for  whom  we  mainly  make  our 
provisions  do  not  know  what  "ANOPHELES"  is,  and  if  they  are  told 
about  the  fever  of  the  mosquito  anopheles,  they  will  then  understand 
that  a  mosquito  is  meant,  and  will  take  the  proper  preventive  measures. 

These  are  all  the  remarks  I  have  to  make  at  present.  When  we 
come  to  discuss  the  respective  recommendations,  I  may  perhaps  have 
something  else -to  say,  since  all  the  delegates  have  treated  many  cases 
in  their  respective  countries,  we  may  have  something  to  say  of  what 
we  have  learned  from  practice  and  experience  in  our  own. 

DR.  LAZO-ARRIAGA.  As  we  are  discussing  the  proposition  made  by 
Dr.  Johnson,  I  take  the  liberty  to  make  a  remark.  Are  all  of  us  con- 
vinced, or  rather  has  science  already  demonstrated  as  a  scientific  fact, 
that  the  only  and  exclusive  cause  of  malaria  is  the  anopheles  ?  If  this 
is  not  so,  would  the  change  of  name  be  proper  ?  It  seems  to  me  there  is 
yet  some  doubt  concerning  this  matter. 

DR.  GUITERAS.  Regarding  the  name  by  which  malaria  should  be 
known,  I  agree  with  Dr.  Mendizabal  as  to  the  difficulty  which  would 
be  encountered  should  we  pretend  to  give  to  the  disease  the  name  of 
the  mosquito,  and  although  I  do  not  know  as  to  other  countries,  yet 
with  regard  to  Cuba  I  do  know  that  in  the  greater  part  of  our  terri- 
tory, the  mosquito  which  transmits  the  disease  is  no  longer  comprised 
in  the  anopheles  species  but  also  in  the  Cellia.  As  to  there  being  another 
way  of  transmitting  malaria,  it  seems  to  me  that  we  might  exclude 
this  point  from  our  discussion,  and,  as  a  practical  hygienist,  I  would 
add  that  there  is  no  other  way  of  transmitting  malaria. 

DR.  AZURDIA.  I  have  something  to  say  on  the  remarks  made  by  Dr. 
Mendizabal  concerning  quinine.  As  is  well  known,  there  are  two  en- 


48  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

tirely  different  means  of  combatting  malaria,  namely,  the  prophylactic 
and  the  curative  methods;  and  from  the  prophylactic  point  of  view, 
we  should  establish  that  quinine  is  not  only  curative  but  also  preven- 
tive. In  view  of  the  above,  the  idea  being  generally  accepted  that  we 
should  not  consider  the  use  of  quinine  as  indispensable  as  is  the  ob- 
servance of  hygienic  rules  I  believe,  nevertheless,  that  it  may  be 
adopted  as  a  preventive  in  combatting  malaria. 

As  to  the  name  proposed  by  Dr.  Johnson,  I  regret  not  to  agree  with 
him.  Dr.  Guiteras  has  stated  that  in  Cuba  the  mosquito  which  trans- 
mits the  disease  is  not  the  same,  and  among  us  malaria  is  known  by 
tne  name  of  "paludismo,"  fevers,  etc.,  etc.  Consequently,  the  change 
of  name  would  not  bring  about  a  general  knowledge  of  the  disease, 
but  it  would  rather  be  the  scientific  denomination  of  the  disease. 

DR.  MENDIZABAL.  I  was  not  opposed  to  the  use  of  quinine ;  I  think 
that  until  the  people  are  able  to  protect  themselves,  it  is  our  duty  to 
recommend  it;  I  only  said  that  I  did  not  find  it  as  efficient  as  hygiene. 

DR.  GONC.ALVEZ  CRUZ.  I  believe  that  the  prophylaxis  of  malaria  can 
not  be  carried  out  in  a  schematic  way,  and  that  it  is  advisable  to  study 
the  regions  where  prophylaxis  should  be  put  in  practice  on  the  works 
in  the  construction  of  railways,  in  the  captation  of  water,  in  the  armies 
while  on  the  field,  in  the  commission  on  exploration,  etc.  Prophylaxis 
should  be  carried  out  using  quinine  as  a  severe  treatment  of  the  patients. 

In  our  cities,  towns,  farms,  etc.,  prophylaxis  should  be  put  in  prac- 
tice waging  war  against  mosquitoes,  protecting  the  houses,  railroad 
stations,  etc.,  by  means  of  wire  gauze.  In  these  different  regions,  it  is 
preferable  to  study  the  species  of  anophelines  existing  therein,  as  we 
have  seen  them  in  Brazil,  especially  in  Sierra  de  Santos,  where  malaria 
is  transmitted  by  a  small  mosquito  called  Myzomya  Lutzi,  which  pene- 
trates wire  gauze  of  half  a  millimeter  in  thickness,  and  which  instead 
of  living  in  swamps  finds  -a  special  way  of  reproducing  itself  in  the 
cavities  of  the  leaves  of  certain  plants  such  as  bromelias.  It  is  for  this 
reason  that  prophylaxis  should  not  be  put  in  practice  schematically, 
but  should  be  oriental  whenever  in  compliance  with  superior  orders, 
it  shall  have  been  established  in  said  regions. 

DR.  JOHNSON.  Mr.  President,  I  would  like  to  join  the  other  gentle- 
men in  congratulating  Dr.  Liceaga  on  the  importance  of  his  remarks 
with  regard  to  malaria. 

I  wish  to  add  that  in  our  section  of  the  country  malaria  is  very  potent 
in  intensifying  the  symptoms  and  the  nature  and  extent  of  other  dis- 
eases. It  is  therefore  most  important  that  the  disease,  which  modi- 
fies so  many  other  diseases,  should  be  removed  from  our  midst  if  that 
be  possible. 

In  the  paper  which  I  read  at  the  Second  International  Sanitary  Con- 
vention, I  drew  attention  to  what  appeared  to  me  to  be  a  valuable 
suggestion  with  respect  to  the  terminology  of  this  malady  and  selecting 
a  name  which  would  at  the  same  time  indicate  its  etiology.  I  sug- 
gested therefore  that  malaria  should  be  known  as  anopheles  fever,  on 
the  ground  that  if  the  public  understood  the  causation  of  this  disease, 
it  would  greatly  facilitate  the  sanitary  work  in  exterminating  it  and 
therefore  we  would  have  the  support  of  the  public  at  large  in  our 
efforts.  I,  therefore,  renew  the  suggestion  on  this  occasion  that  we 
no  longer  use  the  term  "malaria,"  and  suggest  "anopheles  fever."  In 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  49 

the  world  at  large  we  believed  the  disease  came  from  bad  air.  As 
a  matter  of  fact  it  came  from  bad  water  as  carried  about  by  the  mos- 
quito. Now  it  is  known  to  be  propagated  by  the  mosquito.  I  would 
suggest  that  it  be  known  by  the  name  of  "anopheles  fever." 

DR.  JOHNSON.  I  simply  rise  to  say  that  in  my  paper  at  the  last  ses- 
sion I  referred  to  that  point,  that  it  should  be  "mosquito  fever,"  or 
"stegomya  fever"  indicating  the  kind  of  disease. 

Now,  as  we  progress  in  our  study  of  the  disease,  there  seems  to  be 
the  suspicion  that  other  mosquitoes  are  engaged  in  other  diseases — 
for  instance  dengue  fever.  I  think  it  is  well  to  use  the  term  "mosquito 
fever"  and  indicate  which  particular  kind  is  referred  to.  I  accept  the 
suggestion  of  Dr.  Ulloa,  with  that  modification. 

GEN.  WYMAN.  I  would  like  to  inquire  of  the  two  gentlemen,  Dr. 
Guiteras  and  Dr.  Cruz,  whether  these  are  species  of  the  general  class 
of  anopheles  or  not. 

DR.  GUITERAS.  Of  the  anophelenas,  yes.  They  belong  to  the  anophe- 
lene  family,  but  they  belong  to  different  genera. 

DR.  VON  EZDORF.  In  line  with  the  proposition  of  Dr.  Lic6aga  to 
commence  a  crusade  against  malarial  fever,  I  might  add  that  lately 
we  have  acquired  the  quarantine  stations  in  the  South,  Mobile  and 
New  Orleans.  I  can  speak  for  New  Orleans;  there  we  have  been 
detaining  all  passengers  with  malarial  fever  coming  from  the  Central 
American  and  Mexican  ports,  in  fact  from  all  the  Gulf  ports  in  the 
south,  and  the  same  condition  has  been  experienced  in  my  station  as 
with  Dr.  Guiteras,  that  all  the  cases  proved  to  be  malarial  fever,  with 
the  exception  of  twenty,  which  were  typhoid  fever.  I  found  the 
malaria  parasite  in  all  the  cases,  proving  positively  that  they  were 
malaria.  Nearly  all  of  them  proved  to  be  the  aestivo  autumnal  form, 
and  we  know  this  form  causes  a  great  deal  of  difficulty  in  making  a 
definite  diagnosis  between  yellow  fever  and  malaria.  I  think  it  is  an 
excellent  idea  that  we  should  take  the  additional  precaution  to  isolate 
and  hold  malarial  cases  at  quarantine  stations  until  all  doubts  are 
removed  that  they  are  not  complicated  with  yellow  fever. 

The  other  cases — the  typhoid  cases — gave  us  a  great  deal  of  trouble 
in  making  diagnoses,  but  the  malarial  seemed  to  be  the  most  prominent 
I  held  all  such  cases  of  malaria  and  typhoid  fever  at  the  quarantine 
station,  permitting  the  vessel  to  proceed. 

The  point  I  wish  to  make  is  that  the  individual  with  a  fever,  be  it 
malarial  or  typhoid,  was  held  in  quarantine  at  my  station  for  observa- 
tion and  treatment,  thereby  establishing  a  practice  of  quarantine  for 
these  diseases.  I  had  no  cases  of  yellow  fever  this  year. 

It  is  evident  that  my  practice  reduced  the  possibility  of  adding  in- 
fection of  malaria  and  typhoid  fever  in  a  community — where  the  spread 
of  these  diseases  was  favored. 

I  consider  this  practice  justifiable,  and  I  favor  the  recommendation 
of  Dr.  Liceaga  to  isolate  malarial  fever  cases  arriving  in  the  active 
stage  of  the  disease. 

DR.  GUITERAS.  Mr.  Chairman,  I  beg  to  make  the  following  propo- 
sition in  order  to  submit  the  same  to  the  Advisory  Committee  as  an 
addition  to  the  Convention  of  Washington: 

Art.  LI.  Passengers  coming  from  a  zone,  which,  in  the  opinion  of  the  local 


5O  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

sanitary  authorities,  is  infected  with  malaria  to  such  a  degree  as  to  constitute 
a  menace,  shall  be  subject  to  medical  inspection. 

All  persons  who  have  fever  at  the  time  of  inspection  shall  be  transferred 
to  the  hospital  or  to  halls  ad  hoc,  or,  should  they  prefer  it,  shall  be  allowed  to 
go  to  their  residence  where  they  shall  be  subject  to  such  inspection  as  the  local 
authority  may  deem  necessary  during  the  acute  stage  of  the  infection. 

The  Convention  recommends  to  the  American  nations: 

1.  That  through  their  respective  sanitary  authorities,  they  make  a  popular  edu- 
cational propaganda  by  means   of  pamphlets   and   instructions   concerning   the 
etiology  and  prophylaxis  of  malaria. 

2.  That  centers  be  established  for  tihe  free  distribution  of  quinine  among  the 
poor  on  prescriptions  given  by  physicians  and  for  the  treatment  of  cases  of 
malaria. 

3.  That  the  houses  where  the  patients  of  malaria  have  been  treated  be  fumi- 
gated after  the  patients  are  cured. 

Besides,  I  will  suggest  the  following  recommendations  in  the  sense 
in  which  they  have  been  made  by  other  delegates: 

ADAPTATION   OF   THE   CONVENTION   OF   WASHINGTON    TO    EUROPEAN 
COLONIES  IN  AMERICA. 

Whereas,  the  Convention  of  Paris  of  1903,  in  adopting  its  resolutions,  over- 
looked a  very  important  detail  concerning  yellow  fever,  which  was  corrected  by 
the  Convention  of  Washington; 

Whereas,  therefore,  the  European  colonies  on  the  American  continent  are  not 
guided  with  regard  to  yellow  fever  by  the  same  convention  as  the  American 
Republics ; 

Whereas  some  of  said  colonies  frequently  become  a  focus  of  yellow  fever, 

Be  it  resolved,  that  through  the  communication  which  is  to  be  established  be- 
tween our  permanent  Bureau  and  that  of  Paris  the  plan  of  sanitary  measures 
against  yellow  fever  which  was  adopted  at  the  Convention  of  Washington  in  1905 
is  recommended  to  the  consideration  of  European  nations,  either  to  study  them 
separately  at  the  next  Sanitary  Convention  of  European  States,  or  in  any  other 
manner  that  may  be  agreed  upon  between  the  two  permanent  bureaus. 

NATIONALIZATION  OF  THE  SANITARY  SERVICES. 

Whereas  the  success  met  with  on  this  continent  in  recent  years  in  the  cam- 
paign against  endemic  diseases  has  been  due  to  the  intervention  of  Central  Gov- 
ernments ; 

Whereas  on  the  contrary  the  lack  of  means  of  the  legal  authorities,  as  well  as 
the  serious  obstacles  due  to  dualism  in  the  sanitary  authority,  has  become  evident 
time  and  again, 

The  Convention  recommends  to  the  American  States  the  nationalization  and 
centralization  of  the  sanitary  authorities  by  means  of  legislation,  and  the  estab- 
lishment of  a  Department  of  Public  Health. 

THE  CHAIRMAN.  These  recommendations  are  referred  directly  to 
the  Advisory  Committee. 

I  beg  the  delegates,  who  are  members  of  the  Committee  on  Malaria, 
to  study  their  report  and  to  send  the  same  as  soon  as  possible,  in  order 
to  refer  it  to  the  other  Committee.  What  is  wanted  is  that  before  we 
adjourn,  we  may  have  precise  and  definite  resolutions  concerning  this 
subject,  because  the  benefits  to  be  derived  from  this  Convention  can- 
not be  appreciated  unless  they  are  decided  in  an  entirely  practical 
fashion. 

I  beg  to  propose  to  the  Convention  that  we  adjourn  the  session  in 
order  that  both  the  Committee  on  Malaria  and  the  Advisory  Com- 
mittee may  devote  their  attention  to  their  respective  matters,  and  that 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  5! 

Dr.  Wyman  be  allowed  to  present  a  proposition  which  does  not  relate 
to  malaria,  in  the  discussion  of  which  we  have  been  engaged. 
DR.  WYMAN.  I  beg  leave  to  submit  the  following  resolution : 

Resolved,  That  the  Secretary  be  requested  to  include  in  the  printed  transac- 
tions of  the  Third  International  Sanitary  Convention  of  the  American  Republics, 
a  summary  of  all  the  formal  resolutions  adopted  successively  by  the  First  Inter- 
national Sanitary  Convention,  the  Second  and  Third  Conventions. 

In  explanation  of  this  I  would  state  that  there  are  a  number  of  very 
valuable  resolutions  relating  to  sanitary  matters  that  should  not  be  lost 
sight  of,  and  I  think  it  would  be  advisable  to  have  a  review  of  them 
in  the  printed  transactions  of  this  session, 

I  wish  also  to  invite  the  attention,  particularly  of  the  Committee  on 
Trachoma  and  on  Yellow  Fever,  to  the  recent  treatises  on  these  two  sub- 
jects which  have  been  published  by  the  Public  Health  Service  of  the 
United  States.  One  is  on  trachoma,  and  is  a  very  valuable  addition 
to  our  knowledge  of  the  subject,  and  a  review  of  all  the  latest  scientific 
ideas  concerning  that  disease,  and  a  volume  which  is  of  great  practical 
value  both  in  the  diagnosis  of  the  disease  and  particularly  useful  in  the 
efforts  to  keep  trachoma  cases  from  entering  the  country  from  another 
country.  The  second  is  a  very  valuable  practical  work  on  yellow  fever, 
its  etiology,  symptoms  and  diagnosis,  which  was  prepared  particularly 
for  use  by  physicians  who  actually  come  in  contact  with  these  cases 
of  yellow  fever  and  with  doubtful  cases. 

THE  CHAIRMAN.  The  propositions  of  Dr.  Wyman  are  referred  to 
the  Advisory  Committee. 

In  order  to  bring  the  session  to  an  end,  I  beg  the  delegates  to  kindly 
assemble  this  afternoon  at  3  o'clock,  sharp,  because  at  4  o'clock  I  wish 
to  show  them  the  disinfecting  plant  and  offices  of  the  Superior  Board 
of  Health. 

.The  session  was  adjourned. 

Afternoon   Session. 

Dr.  Liceaga,  the  Chairman,  opened  the  session  at  3  o'clock,  the  fol- 
lowing members  being  present:  Drs.  Oswaldo  Gongalvez  Cruz, 
Ricardo  Gutierrez  Lee,  Genaro  Payan,  Hugo  Roberts,  Juan  Guiteras, 
Juan  Horacio  Estevez,  Walter  Wyman,  R.  H.  von  Ezdorf,  P.  J.  Straub, 
J.  Gatewood,  Salvador  Ortega,  Jose  Azurdia,  Luis  Lazo  Arriaga, 
Rodolfo  B.  Gonzalez,  Ernesto  Fernandez  Espiro,  and  the  Secretary, 
Juan  J.  Ulloa. 

The  Chairman  begged  those  present  to  excuse  the  failure  to  read 
the  minutes  of  the  morning  session  at  this  time,  inasmuch  as  there 
was  not  time  in  which  to  prepare  the  same. 

THE  CHAIRMAN.  Gentlemen:  I  have  the  honor  to  introduce  to  you 
Dr.  Ernesto  Fernandez  Espiro,  delegate  of  the  Republic  of  Uruguay 
to  the  Third  International  Sanitary  Convention  of  Mexico,  who  has 
just  arrived,  and  who  was  unable  to  attend  our  sessions  before  be- 
cause, having  started  on  his  journey  on  the  26th  of  October,  he  was 
unable  to  arrive  in  Mexico  until  this  morning.  We  are  exceedingly 
pleased  to  have  him  with  us,  though  he  has  been  unable  to  attend  our 
first  sessions. 


52  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

Dr.  Ulloa  proposed  that  the  name  of  Dr.  Fernandez  Espiro,  delegate 
of  Uruguay,  who  has  just  arrived,  be  added  to  the  list  of  Vice-Presi- 
dents.  This  proposition  was  unanimously  approved. 

DR.  ESPIRO.  Mr.  Chairman  and  delegates:  On  entering  upon  my 
duties  as  a  delegate  to  the  Third  International  Sanitary  Convention  of 
the  American  Republics,  I  cordially  greet  the  Chairman  and  other  dele- 
gates, and  would  say,  at  the  same  time,  that  I  have  exceedingly  re- 
gretted that,  owing  to  unavoidable  circumstances  I  have  not  been 
able  to  arrive  in  due  time  in  order  to  have  the  honor  and  pleasure  of 
attending  the  inaugural  session  of  the  Convention,  but  although  I  have 
not  been  able  to  be  with  you  from  the  beginning,  allow  me  to  hope,  at 
least,  that  I  may,  during  the  remaining  days  of  the  session,  contribute 
to  the  work  we  propose  to  do.  In  the  meantime  I  am  very  glad  to  be 
with  you,  the  distinguished  representatives  of  the  American  Republics, 
who  bring  to  the  deliberations  of  this  Convention  your  knowledge  and 
recognized  experience. 

THE  CHAIRMAN.  Dr.  Ezdorf  wishes  to  make  a  motion  relating  to 
malaria  in  the  discussion  of  which  we  were  engaged  this  morning.  I 
beg  you  to  allow  him  to  read  his  proposition  so  that  it  may  be  referred 
to  the  proper  Committee. 

DR.  EZDORF.  In  order  that  some  of  the  propositions  presented  this 
morning  in  relation  to  malaria  may  become  more  effective,  I  wish  to 
present  the  following  resolution : 

Resolved,  That  the  Permanent  Sanitary  Bureau  at  Washington  be  instructed 
to  distribute  regularly  information  concerning  the  existence  of  malaria  in  their 
several  important  seaboard  cities. 

THE  CHAIRMAN.  This  resolution  is  referred  to  the  Committee  on 
Malaria. 

DR.  ROBERTS.  Bearing  in  mind  that  the  information  received  at  the 
ports  from  the  local  authorities  at  the  places  where  a  ship  arrives,  are 
generally  delayed  because  it  is  necessary  to  print  and  distribute  them, 
etc.,  and  it  being  important  that  physicians  be  advised  in  due'  time  of 
all  the  reports  and  information  that  may  be  useful  to  them  concerning 
public  health  at  the  sailing  of  a  vessel,  I  wish  to  propose  that  upon 
issuing  the  bill  of  health  to  the  vessels,  there  be  specified  therein,  just 
as  other  diseases  are  specified,  the  greater  or  smaller  number  of  cases 
of  malaria  there  are  at  the  moment  of  the  sailing  of  the  vessel,  in  order 
that  on  the  arrival  of  the  same  the  physicians  may  know  all  the  cases 
and  subject  all  the  patients  as  well  as  the  vessel  to  the  proper  treat- 
ment. The  following  is  my  motion : 

Whereas,  the  reports  received  from  the  Central  Bureau  of  Information  gen- 
erally reach  the  local  authorities  with  some  delay,  and  it  being  of  the  utmost 
importance  for  said  authorities  to  know  the  sanitary  conditions  prevailing  in  the 
clearance  ports  of  a  vessel,  especially  with  regard  to  malaria,  the  undersigned 
proposes : 

That  there  be  stated  as  nearly  as  possible  in  the  bills  of  health  issued  to  the 
vessels  the  mortality  caused  by  malaria. 

THE  CHAIRMAN.  I  beg  the  Convention  to  allow  the  motion  just 
made  by  Dr.  Roberts  of  Cuba  to  be  added  to  that  of  Dr.  Ezdorf,  and 
that  both  be  referred  to  the  Committee  on  Malaria. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  53 

The  subject  for  discussion  at  this  evening's  session  is  the  following: 
"Discussion  of  measures  of  International  Sanitary  Police  against  the 
bubonic  plague  and  cholera  proposed  by  the  papers  or  motions  of  the 
delegates." 

Does  any  one  present  desire  to  make  any  remarks?  If  not,  I  will 
read  some  pages  of  this  pamphlet  during  the  fifteen  minutes  I  have 
at  my  disposal. 

At  last  Monday's  session,  as  a  summary,  I  had  the  honor  to  point 
out  the  principal  features  contained  in  this  pamphlet,  but  I  intend  to 
do  so  now  in  a  somewhat  more  detailed  manner  in  order  to  find  out 
what  practical  resolutions  may  be  obtained  from  this  Convention. 

(The  report  was  read,  and  ordered  to  be  inserted  in  the  Appendix, 
page  184.) 

I  wish  to  add  a  few  words :  What  we  did  in  the  case  of  the  bubonic 
plague,  as  well  as  in  the  case  of  yellow  fever,  was  not  precisely  to  con- 
struct hospitals,  nor  lazarettos,  nor  great  establishments.  Inasmuch  as 
what  we  needed  was  a  sanitary  station  like  the  one  I  have  just  de- 
scribed, what  was  done  at  Villa  Union  was  to  select  a  place  (which 
happened  to  be  a  tannery),  and  we  made  partitions,  the  place  was 
properly  disinfected,  and  the  sanitary  station  was  established.  Now, 
as  to  yellow  fever,  whenever  we  wish  to  establish  a  lazarette  at  any 
place,  we  select  a  house  having  three  rooms,  order  it  whitewashed,  put 
in  floors,  screened  doors  and  windows,  and  the  lazarette  is  completed, 
the  first  room  being  used  by  the  watchman,  the  second  by  the  patients, 
and  the  third  as  a  kitchen. 

Besides,  there  are  hospitals  provided  with  wire  frames  5  meters'  wide 
and  3^2  meters  high,  with  double  wire  doors — all  made  so  that  they 
can  be  transported  on  mule  back,  the  whole  structure  being  covered 
with  canvas  and  provided  with  wire  windows.  In  good  weather  the 
canvas  curtain  is  raised,  and  by  means  of  them,  halls  are  formed  around 
the  house.  The  cots  and  chairs  are  carried  folded,  and  the  hospital  can 
be  installed  in  five  hours.  If  you  have  an  opportunity  I  advise  you  to 
employ  this  method. 

DR.  GoNgALVEZ  CRUZ.  To  demonstrate  the  value  of  vaccination  in 
the  prophylaxis  of  the  epidemic,  reference  is  made  to  the  fact  of  having 
completely  controlled,  by  means  of  vaccination  with  the  Manguinhos 
vaccine,  an  epidemic  that  started  in  the  small  village  of  Areia  Branca 
in  northern  Brazil.  All  the  inhabitants  were  vaccinated,  and  the 
epidemic  ceased. 

Another  instance  is  that  members  of  the  family  who  accompanied 
the  patients  to  the  hospital,  and  who  were  admitted  to  the  hospital 
after  being  vaccinated.  There  were  some  persons  who  could  not  be 
vaccinated,  and  contagious  cases  developed  among  them,  while  those 
who  were  vaccinated  did  not  become  infected. 

DR.  FERNANDEZ  ESPIRO.  Mr.  Chairman  and  delegates:  I  am  very 
glad  that  the  reading  of  the  interesting  work  of  Dr.  Liceaga  affords 
me  the  opportunity  of  making  some  brief  remarks  concerning  the 
bubonic  plague  in  Montevideo,  and  I  do  not  say  in  Uruguay,  because 
Montevideo  was  the  only  city  where  this  disease  appeared. 

Until  1901  said  disease  was  entirely  unknown  to  us,  notwithstanding 
the  fact  that  we  were  in  frequent  communication  with  countries  where 


54  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

the  disease  had  appeared  years  before.  In  the  year  mentioned,  the 
first  case  appeared  under  peculiar  circumstances. 

This  happened  in  one  of  the  customs  warehouses,  it  not  having  been 
known  whether  the  case  was  preceded  by  the  death  of  rats.  I  was  at 
that  time  Chairman  of  the  National  Board  of  Health,  and  was  timely 
advised  of  the  fact  by  a  colleague.  I  went  to  the  place  immediately 
and  notified  the  Director  of  the  Experimental  Institute  of  Hygiene 
to  accompany  me,  and  we  did  actually  satisfy  ourselves  that  in  said 
warehouse  there  had  been  dead  rats,  and  some  of  them  stunned.  Some 
of  them  were  gathered  up;  a  bacteriological  diagnosis  was  made,  and 
after  24  hours,  it  was  confirmed  that  it  was  a  case  of  rats  afflicted 
with  the  plague.  I  had  already  prepared  a  list  of  the  employees  of  that 
place,  and  on  the  following  day  I  learned  that  the  foreman  of  said 
warehouse  was  sick  at  his  domicile ;  I  went  there  accompanied  by  an- 
other colleague,  and  with  some  difficulty  made  the  diagnosis,  because 
the  character  of  the  plague  was  quite  irregular,  since  the  disease  was 
accompanied  by  pharyngitis,  though  it  did  not  show  any  ganglionic 
infarct  neither  in  the  groins  nor  in  the  armpits.  After  two  or  three 
days  I  noticed  that  one  of  the  retromaxillar  ganglions  was  infarcted, 
and  we  at  once  removed  and  isolated  the  patient ;  a  puncture  was  made, 
the  necessary  blood  extracted,  and  it  was  proved  that  it  was  a  case 
of  bubonic  plague.  Afterwards  the  necessary  cultures  or  inocula- 
tions were  made.  The  rats  were  killed,  the  house  of  the  patient  was 
disinfected,  and  the  plague  apparently  disappeared  in  Montevideo. 

More  than  six  months  thereafter  I  was  notified  that  in  a  bakery 
near  the  port  there  were  persons  afflicted  with  this  same  disease.  I 
made  the  necessary  investigation,  and  secured  some  very  interesting 
information  which  will  be  a  surprise  to  the  delegates. 

Said  cases  were  imported  from  the  port  of  Asuncion,  Paraguay,  in 
the  following  manner:  From  that  bakery  bags  of  crackers  and  bread 
were  obtained  for  supplying  such  vessels  as  went  to  Matto  Grosso,  and 
the  bags  were  retained  in  said  store  to  be  delivered  again  to  the 
steamer  which  made  the  return  trip.  Said  bags  had  been  kept  in  the 
bakery  where  cases  of  bubonic  plague  had  appeared,  and  upon  their 
return,  the  persons  who  handled  them  were  stricken  with  said  disease. 

Therefore,  it  was  shown  that  the  bubonic  plague  was  imported.  At 
that  time  there  were  three  or  four  more  cases,  and  then  the  disease 
entirely  disappeared. 

But  at  the  beginning  of  the  next  year,  1902,  we  had  a  new  importa- 
tion of  the  plague,  which  occurred  in  another  customs  warehouse 
under  the  following  circumstances:  This  importation  was  also  made 
by  persons  who  used  to  handle  bags  which  had  been  filled  with  coffee 
from  Rio  de  Janeiro,  and  the  four  persons  who  transferred  the  coffee 
from  one  bag  to  another  were  stricken  with  the  disease. 

The  new  cases  resulting  from  this  third  importation  could  not  be 
craced,  and  therefore,  it  was  not  possible  to  know  the  place  whence 
they  came,  nor  was  it  possible  to.  find  out  whether  there  had  been 
epizootic  among  rats.  The  facts  are  that  the  disease  has  appeared  in 
those  places  where  bags  filled  with  cereals,  such  as  wheat  or  corn, 
coming  from  other  countries,  frequently  arrive.  In  short,  the  total 
number  of  cases  occurring  in  'the  port  of  Montevideo  from  1901  to 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  55 

April,  1907,  was  47.  So  that  the  bubonic  plague  has  followed  a  course 
entirely  different  from  that  followed  in  other  countries. 

The  measures  which  have  been  put  in  practice  in  Montevideo  are 
more  or  less  those  indicated  by  Dr.  Liceaga.  The  patient  was  isolated, 
either  at  home  or  in  an  isolated  house,  according  to  the  special  cir- 
cumstances of  the  case;  the  disinfection  of  the  houses  was  made,  the 
rats  were  exterminated,  and  magnificent  results  were  obtained. 

As  we  have,  not  had  a  real  epidemic  of  the  bubonic  plague,  our 
measures  of  an  international  character  have  been  modified.  During 
some  years  we  have  been  practising  the  sanitary  inspection  of  vessels 
coming  from  infected  or  suspicious  ports,  but  we  have  realized  that 
such  measures  were  extremely  exaggerated,  and  when  we  held  our 
Convention  of  1904,  we  only  prescribed  that  the  patient  of  bubonic 
plague  should  be  isolated;  that  first  and  second  class  passengers  may 
land,  provided  they  are  watched  for  five  days  on  land,  and  that  the 
isolation  of  the  third  class  or  steerage  passengers  be  made  at  such  place 
as  the  sanitary  authorities  may  direct. 

We  have  adopted  these  measures  because  we  have  come  to  the  con- 
clusion that  during  the  long  period  of  time  to  which  I  have  referred, 
none  of  the  vessels  coming  from  Rio  de  Janeiro,  where  said  plague  has 
prevailed,  sometimes  in  quite  an  aggravated  form,  in  none  of  said  ves- 
sels occurred  any  case  of  the  bubonic  plague.  Therefore,  since  that 
time,  we  have  given  great  importance — a  capital  importance — to  the 
transmission  of  the  disease  by  means  of  rats. 

This  is  the  reason  why  we  have  not  in  any  way  detained  the  healthy 
passengers,  nor  the  freight  of  the  steamers,  because  we  thought  there 
was  no  reason  to  do  so  in  the  case  of  this  disease.  Our  action  is 
directed  exclusively  to  those  patients  who,  as  I  said  before,  are  isolated 
in  the  department  which  each  of  the  signatory  countries  of  the  Con- 
vention had  at  its  disposal. 

THE  CHAIRMAN.  If  there  are  no  other  remarks  on  this  subject,  the 
session  is  suspended  to  be  reopened  after  the  visit  to  the  Superior 
Board  of  Health,  where  I  wish  you  to  accompany  me. 

Before  closing  the  session,  I  would  state  that  Dr.  Fernando  Espiro 
requests  to  be  allowed  to  read  his  report  in  the  session  of  tomorrow. 

The  Secretary  will  now  read  some  communications  which  have  been 
received. 

THE  SECRETARY  (reading)  : 

AMERICAN    INTERNATIONAL   CONGRESS    ON    TUBERCULOSIS. 

Office  of  the  Secretary  of  the  Council,  No.  39  Broadway. 

New  York,  November  26,  1007. 
To  the  President  and  Secretary  of  the  International  Sanitary  Congress, 

to  be  held  in  December -{  1007,  *»  the  City  of  Mexico. 

GENTLEMEN:    The  following  gentlemen  were  this  day  named  as  Delegates  to 
your  Congress  by  the  Council  of  the  American  International  Congress  on  Tuber- 
culosis, in  whose  action  this  body  takes  a  deep  interest. 
Hon.  Porfirio  Diaz,  President  of  the  Republic  of  Mexico. 
Hon.  Seiior  Ignacio  Mariscal,  Minister  of  Foreign  Relations  of  Mexico,  City 
of  Mexico. 

Hon.  Teodoro  A.  Dehesa,  Governor  of  Vera  Cruz. 
Hon.  Miguel  Cardenas,  Governor  of  Coahuila. 
Hon.  Pedro  L.  Rodriguez,  Governor  of  Hidalgo. 
Hon.  Emilio  PimenteL  Governor  of  Oaxaca. 


5  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

Hon.  Aristeo  Mercado,  Governor  of  Michoacan. 
Col.  Francis  T.  B.  Fest,  M.  D.,  Las  Vegas,  New  Mexico. 
Dr.  Juan  J.  Ulloa,  Secretary  of  the  American  International  Congress  on  Tuber- 
culosis, Consul  General  for  the  Republic  of  Costa  Rica,  City  of  New  York. 

Faithfully  yours, 

CLARK  BELL, 
Secretary  of  the  Council  for  the  Congress. 

MEDICO-LEGAL    SOCIETY- 

Office  of  the  President,  No.  39  Broadway, 

New  York,  November  26,  1907. 
To  the  President  and  Secretary  of  the  International  Sanitary  Congress, 

to  be  held  in  December,  1907,  in  the  City  of  Mexico. 

GENTLEMEN:    The  following  gentlemen  were  this  day  named  as  Delegates  to 
your  Congress  by  the  Executive  Committee  of  the   Medico-Legal  Society,  in 
whose  action  this  body  takes  a  deep  interest 
Col.  Francis  T.  B.  Fest,  M.  D.,  Las  Vegas,  New  Mexico. 

Dr.  Juan  J.  Ulloa,  Secretary  of  the  American  International  Congress  on  Tuber- 
culosis, Consul  General  for  the  Republic  of  Costa  Rica,  City  of  New  York. 

Faithfully  yours, 

CLARK  BELL, 
President  of  the  Medico-Legal  Society. 

THE  CHAIRMAN.  Gentlemen:  I  beg  to  submit  to  the  Assembly  a 
decision  in  connection  with  these  communications. 

The  organization  of  the  Sanitary  Convention  is  different  from  pri- 
vate congresses  or  associations  devoted  to  any  % scientific  subject.  I 
understand  that  no  person  is  admissible  in  our  body  who  is  sent  as  a 
delegate  by  said  corporations,  and  much  less  when  said  persons,  though 
prominent  officials,  are  not  professionals,  because,  as  it  appears,  the 
only  professional  among  them  is  Dr.  Ulloa.  Besides,  the  appointment 
of  delegates  to  this  Convention  has  been  made  by  the  respective  Gov- 
ernments. This  is  my  opinion  concerning  the  matter,  and  is  what  I 
want  to  consult  with  this  body,  and  I  think  that  we  should  answer 
politely  thanking  them,  stating  at  the  same  time  that  it  is  not  possible 
for  us  to  accept  the  representation  of  the  persons  designated.  We  can- 
not accept  such  delegates  of  a  society,  however  important  it  may  be, 
and  however  prominent  the  persons  designated. 

DR.  FERNANDEZ  ESPIRO.  I  understand,  as  Dr.  Liceaga  has  clearly 
stated,  that  the  organization  of  the  Sanitary  Convention  of  the  Ameri- 
can Republics  is  entirely  different  from  the  organization  of  the  Con- 
gresses which  are  held  periodically  in  other  countries;  so  much  so 
that  when  invitations  are  received  to  attend  these  Congresses,  such 
invitations  are  sent  to  the  respective  Governments,  stating  therein 
the  desire  that  they  send  their  delegates,  and  in  such  cases  the  invita- 
tions are  sent  through  the  Minister  of  Foreign  Relations  of  the  country 
extending  the  invitation  to  the  Department  of  Foreign  Relations  of 
the  countries  invited,  and,  therefore,  the  Governments  appoint  the 
delegates;  while,  in  the  present  case,  I  understand  that  it  would  be  a 
private  delegation  which  would  be  accredited  before  this  Convention, 
and,  therefore,  the  acceptance  of  a  thing  we  are  not  authorized  to 
accept,  would  imply  the  establishment  of  an  improper  precedent,  be- 
cause the  Governments  should  make  the  invitation.  Consequently,  I 
second  the  motion  of  Dr.  Liceaga. 

The  motion  of  Dr.  Liceaga  was  unanimously  adopted. 

The  session  adjourned. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION. 


FOURTH  DAY,  THURSDAY,  DECEMBER  5. 
Night  Session. 

The  meeting  was  called  to  order  by  the  Chairman,  Dr.  Liceaga,  the  fol- 
lowing delegates  being  present :  Drs.  Oswaldo  Gongalvez  Cruz,  Ricardo 
Gutierrez  Lee,  Genaro  Payan,  Hugo  Roberts,  Pedro  L.  Ferrer,  Juan 
Horacio  Estevez,  R.  H.  von  Ezdorf,  H.  L.  E.  Johnson,  Salvador 
Ortega,  Jose  Azurdia,  Luis  Lazo  Arriaga,  Ingeniero  Hilario  Elguero, 
Rodolfo  B.  Gonzalez,  Ernesto  Fernandez  Espiro,  and  Juan  J.  Ulloa, 
Secretary. 

The  Secretary  read  the  minutes  of  the  sessions  held  on  the  4th  in- 
stant. 

THE  CHAIRMAN.  The  minutes  are  open  to  discussion.  If  there  are 
no  objections  they  are  approved  as  read. 

We  began  yesterday  the  discussion  relating  to  international  sanitary 
police  measures  against  the  bubonic  plague  and  the  cholera,  proposed 
in  the  reports  of  the  delegates,  or  on  their  special  motions.  As  you 
will  recollect,  we  are  also  discussing  the  bubonic  plague,  and  I  should 
like  to  know  if  anyone  desires  to  say  anything  on  this  subject,  and  if 
there  are  no  remarks  to  be  made,  I  would  ask  if  there  is  anyone  who 
desires  to  make  any  remarks  concerning  cholera. 

As  there  is  no  one  who  wishes  to  make  any  remarks  on  this  subject, 
Dr.  Fernandez  Espiro,  delegate  of  Uruguay,  has  the  floor  for  the  pur- 
pose of  reading  his  essay. 

DR.  FERNANDEZ  ESPIRO.  Before  reading  the  paper  which  I  will  sub- 
mit to  this  Convention,  I  beg  the  Chairman  to  inform  His  Excellency, 
the  President  of  the  Republic,  of  the  contents  of  the  following  cable- 
gram, without  prejudice  to  my  referring  to  it  when  I  have  the  honor 
to  meet  him  personally. 

Montevideo,  December  4,  1907. 
DR.  ESPIRO,  Mexico. 

Council  greets  President  Mexican  Republic  and  members  Convention,  and 
predicts  success. 

VID  AL-  CROVETTO. 

THE  CHAIRMAN.  In  compliance  with  the  request  just  made  by  the 
delegate  of  Uruguay,  I  shall  deliver  to  the  President  of  the  Republic, 
the  cablegram  just  read,  and  I  hope  the  Convention  will  approve  the 
greeting  of  the  President  of  Uruguay.  The  Convention  highly  appre- 
ciates the  sentiments  expressed  by  the  President  of  the  Superior  Board 
of  Health  of  Uruguay,  and  thanks  him  for  it. 

The  delegate  of  Uruguay  then  read  his  report,  which  appears  in 
full  in  the  Appendix,  page  219. 

THE  CHAIRMAN.  Gentlemen:  Before  opening  the  discussion  re- 
ferred to  in  the  program  which  has  been  accepted  by  the  Convention, 
I  would  request  the  members  of  the  same  to  consider  the  place  where 
the  sessions  of  the  next  Convention  should  be  held.  The  decision  con- 
cerning this  subject  appears  in  the  program  for  Saturday,  that  is  to 


58  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

say,  for  the  7th  instant,  but  I  would  like  the  delegates  to  consider  this 
matter  beforehand  in  order  that,  should  there  be  any  discussion,  they 
may  be  well  prepared  for  it,  because  there  are  many  matters  to  be 
discussed  in  Saturday's  morning  session. 

Inasmuch  as  nobody  has  made  any  remarks,  either  concerning  the 
measures  taken  on  the  bubonic  plague  nor  on  cholera,  which  were 
proposed  by  the  delegates,  we  will  proceed,  as  agreed  upon,  to  the 
subject  to  be  discussed  tonight,  namely,  "Discussion  on  the  Measures 
to  Protect  against  Trachoma,  Beri-beri,  and  other  chronic  transmissible 
diseases." 

DR.  FERNANDEZ  ESPIRO.  I  should  like  at  least  to  know  the  views  of 
the  delegates  concerning  the  measures  relating  to  the  bubonic  plague 
and  Asiatic  cholera,  because  I  think  the  Convention  should  make  some 
decision  on  this  point. 

THE  CHAIRMAN.  Before  the  delegates  express  their  opinion  on  the 
subject,  I  beg  to  inform  them  that  the  motion  just  made  is  included 
in  the  resolutions  adopted  by  the  Conference  of  Rio  de  Janeiro,  and, 
besides,  it  is  also  included  in  our  program. 

The  following  are  the  resolutions  adopted  by  the  Third  Interna- 
tional Conference  of  American  States  held  at  Rio  de  Janeiro  in  August, 
1906,  which,  among  other  measures,  point  out  certain  subjects  which 
the  Sanitary  Convention,  to  be  held  in  the  City  of  Mexico,  shall  take 
into  consideration: 

RESOLUTIONS   ADOPTED   AT   RIO   DE   JANEIRO    IN    AUGUST,    1906. 

The  Third  International  American  Conference  recognizes  the  utility  of  the 
principles  of  international  sanitary  police  which  inspired  the  last  convention 
celebrated  in  Rio  de  Janeiro,  applicable  to  a  definite  region  and  the  convention 
signed  in  Washington  on  the  I4th  of  October,  1905,  which  is  applicable  to  all  the 
nations  of  America,  and,  in  virtue  of  this,  recommends  to  the  countries  here 
represented : 

1.  That  as  a  general  rule  they  adopt  the  said  International  Sanitary  Conven- 
tion of  Washington,  adhering  to  it  and  putting  its  precepts  into  practice. 

2.  The  adoption  of  measures  tending  to  obtain  the  sanitation  of  the  cities, 
and  especially  of  the  ports,  and  to  attain  as  far  as  possible  to  a  better  knowledge 
and  a  greater  observance  of  hygienic  and  sanitary  principles. 

3.  The  advisability  that  all  American  nations  attend  the  next  International 
Sanitary  Convention  to  be  celebrated  in  the  City  of  Mexico  in  December,  1907, 
and  that  they  instruct  their  respective  delegates  to  study  and  solve  the  follow- 
ing points : 

(a)  Practical  means  of  rendering  effective  the  second  of  the  present  recom- 
mendations. 

(b)  Establishment  and   regulation  in  each  of  the  American  countries  of  a 
committee  composed  of  three  medical  or  sanitary  authorities  to  constitute,  under 
the  direction  of  the  International  Sanitary  Bureau,  established  at  Washington, 
an  international  sanitary  informing  committee  of  the  American  Republics,  con- 
tributions to  meet  and  to  communicate  between  themselves  data  referring  to 
public  health  and  for  any  other  purpose  that  the  Convention  may  think  proper. 

(c)  Establishment  and  regulation  in  some  place  in  South  America  designated 
by  the  Convention  of  a  center  of  sanitary  information  that  shall  supply  to  the 
already  existing  International  Sanitary  Bureau  the  elements  necessary  to  carry 
out  the  recommendations  5,  6  and  7  on  sanitary  police  made  by  the  second 
International  American  Conference. 

(d)  Establishment  of  relations  between  the  International  Bureau  established 
at  Washington  and  the  Bureau   Sanitaire  International  of  Paris,  in  order  to 
obtain  the  best  information  in  sanitary  matters  and  take  resolutions  tending  to 
the  object  entrusted  to  both  Bureaus. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  59 

4.  In  accordance  with  the  provisions  of  the  Article  3,  paragraph  c,  the  city  of 
Montevideo  is  hereby  designated  as  the  seat  of  the  center  of  sanitary  information. 

I  am  going  to  take  the  liberty  of  reading  other  declarations  of  the 
former  Convention.  It  was  said  in  the  first  Convention  that  un- 
doubtedly the  work  of  the  Convention  was  based  on  the  resolutions 
of  the  International  American  Conference  held  in  this  city  from  the 
latter  part  of  1901  to  January,  1902.  Those  resolutions  are  as  follows: 

First.  That  all  measures  relating  to  the  subjects  of  international  quarantine, 
the  prevention  of  the  introduction  of  contagious  diseases  into  a  country,  and  the 
establishment  and  control  of  maritime  and  of  international  land  detention,  or 
health  stations,  shall  be  wholly  within  the  control  of  the  National  Governments. 

Second.  That  there  shall  be  established  in  the  ports  of  each  country  two  kinds 
of  detention  (a)  that  for  inspection  or  observation,  and  (b)  that  for  disin- 
fection. 

Third.  That  prohibitive  quarantine  on  manufacturers  and  merchandise  shall 
be  abolished  and  that  merchandise  proceeding  from  non-infected  ports  or  places, 
and  which  passes  through  infected  territory  without  being  detained  therein  be- 
yond the  necessary  time  of  transit,  shall' not  be  subject  to  detention  or  other 
sanitary  measures  beyond  that  of  the  inspection  which  may  be  considered  neces- 
sary at  its  destination,  and  that  such  inspection  and  delay  shall  not  exceed  the 
time  absolutely  necessary  therefor.  Further,  that  this  same  regulation  shall 
apply  equally  to  international  communication  by  railway,  provided  that  live  stock, 
hides,  rags,  and  immigrants'  effects  be  excepted  from  the  above  provisions. 

Fourth.  That  the  Governments  represented  in  this  Conference  shall  co-operate 
with  each  other,  and  lend  every  possible  aid  to  the  municipal,  provincial  and  local 
authorities,  within  their  respective  limits,  toward  securing  and  maintaining  effi- 
cient and  modern  sanitary  conditions  in  all  their  respective  ports  and  territories, 
to  the  end  that  quarantine  restrictions  may  be  reduced  to  a  minimum,  and  finally 
abolished.  Further,  that  each  and  all  of  their  respective  health  organizations 
shall  be  instructed  to  notify  promptly  the  diplomatic  or  consular  representatives 
of  the  Republics  represented  in  this  Conference,  stationed  within  their  respective 
territories,  of  the  existence  or  progress  within  their  several  respective  territories, 
of  any  of  the  following  diseases :  Cholera,  yellow  fever,  bubonic  plague, 
smallpox,  and  of  any  other  serious  pestilential  outbreak.  And  that  it 
shall  be  made  the  duty  of  the  sanitary  authorities  in  each  port,  prior  to  the  sailing 
of  a  vessel,  to  note  on  the  vessel's  bill  of  health  the  transmissible  diseases  which 
may  exist  in  such  port  at  that  time. 

Fifth.  The  Second  International  Conference  of  the  American  States  further 
recommends,  in  the  interest  of  the  mutual  benefit  that  would  be  derived  there- 
from by  each  of  the  American  Republics,  and  that  they  may  more  readily  and 
effectively  co-operate  one  with  the  other  in  all  matters  appertaining  to  the 
subjects  mentioned  in  the  above  resolutions,  that  a  general  convention  of  rep- 
resentatives of  the  health  organizations  of  the  different  American  Republics 
shall  be  called  by  the  governing  board  of  the  International  Union  of  American 
Republics  to  meet  at  Washington,  D.  C.,  within  one  year  from  the  date  of  the 
adoption  of  these  resolutions  by  this  Conference;  that  each  Government  repre- 
sented in  this  Conference  shall  designate  one  or  more  delegates  to  attend  such 
convention ;  that  authority  shall  be  conferred  by  each  Government  upon  its  del- 
egates to  enable  them  to  join  delegates  from  the  other  Republics  in  the  conclu- 
sion of  such  sanitary  agreements  and  regulations  as  in  the  judgment  of  said  con- 
vention may  be  in  the  best  interests  of  all  the  Republics  represented  therein ; 
that  voting  in  said  convention  shall  be  by  Republics,  each  Republic  represented 
therein  to  have  one  vote;  that  said  convention  shall  provide  for  the  holding 
of  subsequent  sanitary  conventions  at  such  regular  times  and  at  such  places  as 
may  be  deemed  best  by  the  contention;  and  that  it  shall  designate  a  permanent 
executive  board  of  not  less  than  five  members,  who  shall  hold  office  until  the 
next  subsequent  convention,  at  which  time  the  board  shall  be  appointed  with  a 
chairman  to  be  elected  by  ballot  by  the  convention;  the  said  executive  board 
to  be  known  as  the  "International  Sanitary  Bureau,"  with  permanent  headquar- 
ters at  Washington,  D.  C. 

Sixth.  That  in  order  that  the  International  Sanitary  Bureau  thus  provided 
for  may  render  effective  service  to  the  different  Republics  represented  in  the 


6O  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

convention,  the  said  Republics  shall  promptly  and  regularly  transmit  to  said 
Bureau  all  data  of  every  character  relative  to  the  sanitary  condition  of  their 
respective  ports  and  territories  and  furnish  said  Bureau  every  opportunity  and 
aid  for  a  thorough  and  careful  study  and  investigation  of  any  outbreaks  of  pes- 
tilential diseases  which  may  occur  within  the  territory  of  any  of  the  said 
Republics,  to  the  end  that  said  Bureau  may  by  those  means  be  enabled  to  lend 
its  best  aid  and  experience  toward  the  widest  possible  protection  of  the  public 
health  of  each  of  the  said  Republics,  and  that  commerce  between  said  Republics 
may  be  facilitated. 

Seventh.  That  the  salaries  and  expenses  of  the  delegates  to  the  convention  and 
of  the  members  of  the  International  Sanitary  Bureau  herein  referred  to  and 
recommended,  shall  be  paid  by  their  respective  Governments,  but  that  the  office 
expenses  of  special  investigations  it  may  make,  together  with  those  for  the  trans- 
lation, publication  and  distribution  of  reports,  shall  be  paid  from  a  special  fund 
to  be  created  by  annual  appropriations  by  the  Republics  represented  in  such 
conventions,  on  the  same  basis  now  in  force  between  the  American  Republics 
for  the  maintenance  of  the  Bureau  of  American  Republics.  Further,  that  in  the 
interest  of  economy,  the  said  Bureau  of  American  Republics  shall  be  utilized 
by  the  conventions  herein  referred  to,  and  by  the  International  Sanitary  Bureau 
herein  recommended  to  the  fullest  extent  possible,  for  the  correspondence,  ac- 
counting, disbursing,  and  preservation  of  the  records  incident  to  the  work  com- 
prised within  these  resolutions. 

Now  should  each  Congress  pretend  to  modify  fundamentally  the 
above  resolutions,  we  could  never  agree,  while  if  we  take  that  basis  as 
a  fixed  one,  the  way  will  be  easy. 

I  said  before  that  that  resolution  of  the  Rio  Conference  answers  the 
questions  just  made  by  Dr.  Fernandez  Espiro,  who  maintains  that  it  is 
necessary  to  decide  this  point.  Said  resolutions  have  already  been 
adopted  at  the  Sanitary  Convention  of  Washington,  which  was  signed 
on  October  14,  1905.  The  Convention  refers  precisely  to  these  three 
points: — the  bubonic  plague,  cholera,  and  yellow  fever,  and  all  these 
resolutions  were  taken  and  adopted  ad  referendum,  and  have  been 
approved  by  nine  American  Republics  because  they  contain  all  the 
data  that  sanitary  science  has  been  able  to  gather  on  these  subjects  up 
to  the  present  time. 

As  we  have  already  stated,  the  Washington  Convention  represents 
an  improvement  on  the  Paris  Convention,  and  the  latter  is  nothing  but 
an  improvement  on  what  was  done  before,  in  1903,  at  that  capital. 
The  Convention  of  Paris  did  nothing  but  to  improve  that  of  Dresden, 
as  the  latter  did  nothing  but  to  improve  that  of  Vienna,  and  the  latter 
that  of  Rome.  Therefore,  in  an  inverse  order,  that  of  Rome  was  im- 
proved by  that  of  Vienna,  the  latter  by  that  of  Dresden,  which  was  im- 
proved by  that  of  Paris,  and  finally  this  latter  was  improved  by  the 
second  of  Paris.  The  Convention  of  Washington  is  based  entirely  on 
the  Second  of  Paris.  Yellow  fever  is  unknown  in  Europe,  but  such 
is  not  the  case  in  the  European  colonies  in  America. 

Let  us  now  see  to  what  extent  that  Convention  interests  us.  The 
importance  of  the  Paris  Convention  of  1903  consists  in  the  fact  that  it 
represents  the  work  of  the  most  prominent  men,  not  only  in  sanitary 
science,  but  also  in  matters  referring  to  commerce  and  its  relations, 
that  is  to  say,  of  the  most  experienced  diplomats  in  sanitary  science, 
and  the  question  they  proposed  to  solve  was  the  following:  To  guard 
our  ports  and  our  different  nations  from  exotic  diseases  in  such  man- 
ner as  not  to  interfere  with  the  present  modus  vivendi  of  society, 
which  at  present  comprises  river  navigation  as  well  as  maritime  navi- 
gation, and  railroad  communication,  so  that  each  of  these  conventions 


THIRD    INTERNATIONAL    SANITARY    CONVENTION,  •     6l 

has  brought  together  a  number  of  scientists  who  have  discussed  the 
matter  to  the  greatest  possible  extent.  Of  course,  we  can  not  say  that 
our  countries  have  the  number  and  importance  of  the  means  of  com- 
munication which  European  countries  have,  and  that,  in  an  exceedingly 
small  territory,  said  nations — with  a  great  network  of  railroads,  and 
with  a  large  number  of  ships  on  the  Atlantic  and  Pacific  oceans — have 
shown  themselves  to  be  very  rich,  and  at  the  same  time  to  have  an 
enormous  commerce. 

Therefore,  those  interested  in  commerce  and  navigation  have  borne 
in  mind  the  great  importance  of  sanitation;  and  if  now  at  a  Congress 
which  will  last  only  two  days  more,  we  should  undertake  to  study  this 
question  anew,  no  matter  how  much  learning  we  might  show  on  the 
subject,  and  however  in  earnest  we  might  be  about  it,  it  would  be 
impossible,  absolutely  impossible,  to  reach  more  precise,  accurate, 
scientific  and  humane  conclusions  than  those  set  forth  at  the  conven- 
tions of  Paris  and  Washington.  If,  therefore,  we  possess  a  code  al- 
ready made,  could  we  do  anything  better  than  adhere  to  it? 

Unfortunately  for  us,  Dr.  Fernandez  Espiro  was  not  present  at  the 
first  session,  in  which  we  earnestly  tried  to  demonstrate  the  advisa- 
bility of  all  the  nations  of  the  earth  having  only  one  common  law 
which  should  govern  all  of  them,  and  since  this  law  is  already  made, 
and  has  been  deeply  studied  and  improved  in  five  international  Euro- 
pean conferences,  as  well  as  in  that  of  Washington,  said  law  is  our 
law.  Having  a  code  in  which  all  these  questions  have  been  exhaus- 
tively studied,  what  better  resolution  could  this  convention  adopt,  than 
to  have  all  its  members  here  present,  who  are  fully  empowered  to  sign 
ad  referendum,  adhere  to  it? 

I  anticipate  the  remarks  that  Dr.  Fernandez  Espiro  might  make 
concerning  the  Convention  held  in  his  country,  and  would  answer  him 
that  it  would  be  impossible  to  accept  it,  for  the  reason  that  that  Con- 
vention can  only  have  a  local  application,  and  can  nor  be  applied  to 
all  countries,  as  was  stated  by  the  Rio  de  Janeiro  Conference,  and  is 
only  to  be  taken  into  consideration  with  regard  to  the  countries  that 
have  intimate  relations  with  each  other,  but  the  Convention  of  Wash- 
ington is  very  desirable  for  the  whole  Continent. 

i  beg  the  delegates  to  take  into  consideration  the  fact  that  any  reso- 
lution they  may  adopt,  considering  the  short  time  at  our  disposal, 
could  not  by  any  means  solve  the  question.  Therefore,  what  better, 
more  important  and  far  reaching  thing  could  we  do  in  behalf  of  our 
respective  countries  than  to  adopt  the  best  code  in  existence  ?  I  do  not 
hesitate  to  say  that  I  consider  this  the  work  of  many  generations  of 
diplomats,  of  many  physicians  and  scientists,  and,  consequently,  this 
seems  to  be  the  latest  expression  on  sanitary  science,  and  I  would 
once  more  beg  the  delegates  who  have  not  yet  accepted  it,  to  adopt  it. 

Gentlemen,  in  the  name  of  humanity,  let  us  accept  this  code.  (Ap- 
plause.) 

DR.  FERRER.  I  wish  to  say  a  few  words  in  answer  to  my  colleague 
from  Uruguay.  At  the  first  and  second  sessions,  the  delegation  of 
Chile  presented  detailed  reports  concerning  the  bubonic  plague  and 
the  course  of  the  epidemic,  as  well  as  what  has  been  done  in  our  coun- 
try in  regard  to  this  matter.  Said  delegation  did  not  present  definite 
conclusions,  for  the  same  reasons  which  have  just  been  set  forth  by 


62  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

the  Honorable  Chairman,  and  therefore  it  only  stated  the  course  of 
the  epidemic,  and  indicated  all  that  has  been  done  in  Chile,  where  the 
resolutions  of  the  Convention  of  Washington  are  strictly  observed,  al- 
though this  Convention  has  not  yet  been  approved  because  the  pro- 
ceedings incidental  thereto  are  rather  slow,  but  the  President  has  al- 
ready approved  them,  he  himself  having  so  stated,  even  though  Con- 
gress has  taken  no  definite  action  in  the  matter. 

MR.  CHAIRMAN.  On  our  trip  from  Washington  to  this  city,  we  had 
the  pleasure  to  read  a  cablegram  sent  by  the  Chilean  Government  to 
our  Minister  in  said  capital,  saying  that  the  President  had  sent  a  mes- 
sage to  Congress  requesting  the  prompt  approval  of  this  Convention. 

DR.  FERNANDEZ  ESPIRO.  When  I  made  my  remarks,  I  did  not  intend 
to  provoke  a  discussion  on  the  subject,  and  I  spoke  because  I  thought 
something  ought  to  be  said  concerning  the  prophylaxis  of  those  dis- 
eases, since  these  points  are  included  in  the  program,  -and  the  Chairman 
a  moment  ago  declared  that  if  nobody  had  anything  to  say  concerning 
the  measures  that  should  be  adopted  against  the  bubonic  plague  and 
cholera,  the  discussion  would  be  continued. 

I  am  perfectly  aware  of  the  evolution  of  all  the  sanitary  conven- 
tions quoted  by  the  Chairman  down  to  the  last  Convention  of  Paris, 
but  I  am  not  convinced,  as  our  colleagues  seem  to  be,  that  the  conven- 
tion of  1903  has  stated  the  latest  expression  in -the  matter  of  interna 
tional  prophylaxis,  and  so  convinced  am  I  of  this  fact,  Mr.  Chairman, 
that  I  entertain  the  hope  that  when  the  sanitary  convention  of  Paris 
comes  to  be  revised,  or  when  a  new  convention  is  held,  the  provisions 
relating  to  the  international  prophylaxis  of  yellow  fever,  cholera  and 
the  bubonic  plague  will  be  entirely  modified,  and  from  said  conven- 
tions will  be  omitted  a  thing  that  is  at  present  done,  namely,  the  sani- 
tary inspection  of  passengers.  I  hope,  Mr.  Chairman,  that  what  we 
have  done  in  our  Sanitary  Convention  of  1904  may  be  adopted  by  sub- 
sequent conventions,  and  that  the  measures  of  international  prophylaxis 
will  be  limited  to  the  detention  and  isolation  of  sick  passengers,  and 
to  the  inspection  on  land  of  all  passengers  who  are  not  afflicted  with 
any  of  these  diseases — that  is  to  say,  that  this  inspection  will  be  sub- 
stituted by  what  used  to  be  done  before  in  the  lazarettos  and  by  what 
has  been  "done  afterwards  on  board  the  vessels.  In  short,  that  the 
words  "Sanitary  Inspection"  shall  be  omitted  in  said  convention,  words 
which  have  been  kept  in  force  in  the  case  of  vessels  infected  with  the 
plague,  and  also  in  a  practical  manner  in  the  case  of  vessels  having  on 
board  cholera  or  yellow  fever  patients.  For  this  reason,  I  do  not  share 
the  opinion  that  the  Sanitary  Convention  of  Paris,  notwithstanding  the 
fact  that  prominent  sanitary  experts  participated  in  it,  contains  the 
latest  expression  concerning  the  international  prophylaxis  of  these 
diseases,  nor  do  I  believe  that  it  represents  the  opinion  of  those  who 
did  not  take  part  in  said  international  convention,  but  who,  neverthe- 
less, have  devoted  many  years  of  their  life  to  the  study  of  these  diseases 
and  of  the  most  efficient  means  of  combatting  them.  Finally,  in  order 
not  to  tire  my  colleagues,  I  would  say  that  I  am  convinced  that  in  future 
the  sanitary  treatment  imposed  on  vessels  having  on  board  patients  of 
this  kind,  will  be  radically  modified,  and  that  the  only  prophylaxis,  and 
the  most  humane,  that  is  to  say,  the  most  advisable  for  the  commercial 
interchange  among  nations,  as  welt  as  for  the  purpose  of  international 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  63 

relations,  should  be  the  inspection  of  passengers  on  land,  and  the  isola- 
tion of  the  patients  in  lazarettos,  or  other  suitable  places,  omitting 
any  other  sanitary  measures  concerning  merchandise  of  whatever  kind. 

THE  CHAIRMAN.  I  am  very  glad  to  have  heard  the  reply  of  Dr. 
Fernandez  Espiro,  but  I  must  correct  what  I  said,  and  I  do  so  with 
the  greatest  pleasure.  I  should  not  have  said,  the  latest  expression  of 
science,  but  the  latest  accepted  legislation.  This  is  the  proper  expres- 
sion. 

I  beg  now  to  express  my  personal  views  on  the  matter,  and  it>  seems 
to  me  that  we  have  been  of  the  same  opinion.  In  the  session  of  day  be- 
fore yesterday,  I  said  that  it  was  necessary  to  omit  the  inspection,  which 
shows  that  that  is  my  personal  conviction,  and  I  shall  so  maintain 
continually;  but,  gentlemen,  we  have  not  yet  reached  that  stage.  If 
we  had  time  enough  to  study,  I  would  certainly  adhere,  without  any 
restriction  whatever,  to  what  Dr.  Fernandez  Espiro  has  just  said,  but 
we  have  only  two  days  at  our  disposal  in.  which  to  do  our  work.  Now, 
can  we  make  any  modifications  in  two  days  ? 

DR.  FERNANDEZ  ESPIRO.  Mr.  Chairman,  I  have  not  advocated  any 
modification  whatever,  and  simply  desired  to  make  known  my  opinion 
on  the  subject. 

THE  CHAIRMAN.  I  take  advantage  of  this  opportunity  to  repeat  that 
I  should  not  say  the  latest  expression  of  science,  but  the  last  agree- 
ment, and  this  is  the  point  upon  which  I  shall  insist. 

My  opinion  is  that  sanitary  laws  are  behind  the  times,  but  if  we  can 
not  make  any  modification  at  this  moment,  which  of  these  two  ways 
is  the  most  acceptable?  To  accept  something  that  is  not  the  best,  but 
which  has  already  been  accepted  by  27  nations,  or  to  introduce  sani- 
tary modifications  in  two  days,  which  is  the  only  time  we  have  at  our 
disposal,  which  of  the  two  ways  is  the  most  practical  ? 

Fortunately  we  have  already  entered  an  epoch  in  which  idealism 
has  to  submit  to  reality,  however  terrible  the  latter  may  be,  and  we 
are  compelled  to  accept  the  current  coin,  that  is  to  say,  the  Convention 
of  Paris,  which  has  been  accepted  by  27  countries,  and  we  hope  that 
the  new  conventions  may  improve,  and  they  will  surely  improve,  the 
sanitary  laws. 

Let  us  accept  said  convention  for  the  present — the  time  will  come 
when  it  can  be  modified — because  it  is  better  to  accept  these  interna- 
tional sanitary  laws,  however  deficient  they  may  be,  than  to  have  none. 

I  beg  to  make  a  formal  motion:  That  one  of  the  resolutions  to  be 
voted  upon  at  the  session  to  be  held  on  Saturday  morning,  be  in  the 
following  terms : 

That  the  delegates  of  the  nations  here  assembled  adhere  to  the  Convention  of 
Washington  of  1905,  and  that  those  countries  which  have  already  adhered  to  it, 
but  whose  adhesion  has  not  been  ratified  by  their  respective  Governments,  pro- 
pose the  ratification  thereof. 

I  request  the  Third  International  Convention  to  accept  this  resolu- 
tion. I  also  request  that  this  proposition,  like  the  former  ones,  be 
referred  to  the  Advisory  Committee. 

Let  us  now  continue  to  consider  the  matter  we  were  discussing,  and 
which  refers  to  the  measures  that  should  be  taken  to  protect  ourselves 
against  trachoma,  beri-beri,  and  other  transmissible  chronic  diseases. 


O4  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

In  order  to  encourage  the  discussion  on  this  point,  I  will  read  the 
following : 

The  easy  intercourse  among  men,  either  by  land  or  by  sea,  has  brought  about 
two  great  benefits  to  mankind ;  but  since  there  is  no  advantage  without  some 
disadvantage  the  facilities  which  steamers  and  railroads  afford  for  transportation 
have  also  their  disadvantages. 

Men  in  traveling  carry  with  them  the  diseases  from  which  they  suffer.  The 
International  Sanitary  Police  has  earnestly  tried,  even  to  exaggeration,  to  pre- 
vent quickly  developed  transmissible  diseases  from  being  brought  into  ports,  or 
border  cities,  or  more  accurately  speaking,  to  render  very  difficult  the  transmis- 
sion of  these  diseases,  keeping  the  patients  of  said  diseases  or  those  who  are  sus- 
pected of  being  stricken  with  them  on  the  vessels  on  which  they  come,  or  in 
special  lazarettos,  but  with  regard  to  transmissible  chronic  diseases,  legislators 
have  not  until  now  given  any  attention  to  them,  and  yet  it  is  just  as  necessary 
to  take  precautionary  measures  against  transmissible  diseases  that  quickly  de- 
velop as  it  is  of  those  which  develop  slowly,  and  are  called  chronic. 

Now  that  Asiatic  immigration  encounters  such  great  difficulties  in  entering 
the  United  States  of  North  America,  it  has  been  directed  toward  Latin-America. 
Through  the  port  of  Salina  Cruz  there  arrives  in  Mexico  every  month  one  or 
two  steamers  bringing  Chinese  immigrants  and  some  of  them  Japanese. 

Our  sanitary  code  prescribes  that  there  shall  only  be  allowed  to  enter  the 
Republic  such  persons  as  desire  to  be  transported  to  it  as  immigrants,  when  they 
have  a  certificate  of  health  showing  them  to  be  in  a  perfectly  healthy  condition, 
issued  by  the  proper  authority  of  the  place  whence  they  come,  and  countersigned 
by  the  Mexican  Consul.  In  accordance  with  the  same  code,  the  certificates  issued 
two  months  prior  to  the  date  of  arrival  of  the  immigrants  to  our  country  are 
void.  (Article  49  of  the  Sanitary  Code.) 

But  this  measure  was  insufficient  because  the  immigrants  might  have  left  their 
country  having  the  diseases  in  incubation  and  arrive  at  our  ports  after  the  latter 
have  developed.  Attention  should  be  called  to  the  fact  that  our  situation  favors 
the  transmission  of  diseases,  because  the  vessels  do  not  touch  at  any  port,  but 
come  directly  from  the  Orient  to  pur  Pacific  ports.  In  view  of  the  above,  rules 
have  been  issued  referring  to  Asiatic  immigration,  a  brief  outline  of  which  is 
as  follows: 

Immigrants  shall  come  provided  with  a  certificate  of  health  issued  by  a  physi- 
cian at  the  place  of  departure,  and  countersigned  by  the  Mexican  Consul  in  such 
place,  and  in  the  absence  of  the  latter,  by  the  Consul  of  the  United  States  of 
North  America. 

Immigrants  will  only  be  admitted  through  the  port  of  Salina  Cruz  when  their 
number  exceeds  ten,  but  when  in  smaller  numbers  they  are  allowed  to  land  at 
the  ports  of  Acapulco,  Mazatlan,  Guayamas,  Tampico,  Veracruz,  or  Coatzacoalcos. 

All  vessels  with  immigrants  on  board  are  received  in  accordance  with  the  pro- 
visions of  the  Sanitary  Code,  the  Maritime  Sanitary  Regulations,  and  such 
special  rules  as  may  be  issued  by  the  Superior  Board  of  Health  in  each  case,  as 
circumstances  may  require. 

If  no  special  circumstances  exist,  the  healthy  immigrants  are  allowed  to  land 
without  delay,  and  are  taken  directly  through  a  special  wharf  to  the  lazaretto 
reserved  for  them.  There  they  are  compelled  to  bathe,  their  clothes  and  baggage 
are  disinfected,  and  subject  to  an  inspection  for  ten  days. 

If  at  the  end  of  this  period  no  disease  develops  among  them,  they  are  allowed 
to  leave,  the  health  delegate  duly  notifying  the  Superior  Board  of  Health  con- 
cerning the  place  of  destination  of  each  of  the  immigrants. 

Heretofore  the  foregoing  measures  have  been  sufficient  to  guard  us  against 
cholera,  bubonic  plague  and  yellow  fever,  but  they  were  not  able  to  prevent  some 
patients  of  beriberi  from  entering  the  country. 

Inasmuch  as  this  disease  was  entirely  unknown  in  Mexico,  and  since,  on  the 
other  hand,  the  patients  had  it  only  in  an  undeveloped  stage  in  which  it  was  not 
easy  to  detect  it  by  the  symptoms,  which  make  it  easily  detected  when  it  is  in  an 
advanced  stage,  there  were  several  cases  in  Salina  Cruz,  Tehuantepec  and  Santa 
Lucretia,  but  only  among  the  immigrants  themselves.  As  soon  as  the  sanitary 
authorities  discovered  these  cases,  they  demanded  that  the  patients  should  be 
re-embarked  for  their  country,  and  that  no  person  afflicted  with  beriberi  should 
be  allowed  to  land. 

The  disease  called  trachoma  was  known  in  Mexico  only  by  occulists,  and  it  must 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  65 

have  been  so  rare  that  physicians  generally  did  not  know  of  it,  and  much  less 
the  people. 

Dr.  Lorenzo  Chavez,  a  distinguished  occulist,  had  occasion  last  year  to  note 
a  small  epidemic  of  trachoma  in  a  government  school,  and  called  attention  to  the 
danger  of  the  same  being  spread.  This  fact  caused  the  sanitary  authorities  to 
think  of  the  possibility  of  the  Asiatic  immigrants  bringing  trachoma  and  of 
the  danger  of  their  spreading  said  disease  throughout  the  country;  and  as  the  dele- 
gates of  the  Board  of  Health  at  the  ports  were  advised  of  said  danger,  they 
have  commenced  to  enumerate  the  number  of  trachoma  patients  arriving  in  the 
Republic,  a  greater  number  arriving  at  Pacific  than  at  Gulf  ports.  In  one  of 
these  steamers  there  were  220  trachoma  patients.  Then  the  Superior  Board  of 
Health  requested  the  Secretary  of  the  Interior  to  prohibit  the  landing  of  such 
immigrants,  and  they  were  actually  re-embarked  for  China,  and  thus  the  Depart- 
mental declaration  that  such  patients  would  not  be  allowed  to  land  in  any  of  the 
Gulf  or  Pacific  ports  .was  obtained. 

In  order  to  prevent  the  introduction  of  the  aforesaid  diseases,  the  immigrants 
are  thoroughly  inspected  before  they  embark  at  the  port  of  Hong  Kong,  whence 
Chinese  immigrants  generally  come.  To  this  end  a  physician  representing  the 
Superior  Board  of  Health  was  sent  to  said  port,  and  he  prevents  immigrants 
afflicted  with  the  bubonic  plague,  cholera,  and  other  transmissible  and  quickly 
developed  diseases  from  embarking  there. 

A  law  is  now  under  consideration  to  prevent  patients  afflicted  with  tubercu- 
losis, leprosy,  scrofula,  malaria  (with  visible  symptoms),  beriberi,  cerebro-spinal 
meningitis,  trachoma,  and  other  transmissible  chronic  diseases  from  landing  in 
our  ports. 

Said  law  will  likewise  prohibit  the  landing  of  the  insane,  the  aged,  idiotic  chil- 
dren, persons  whose  constitution  has  been  greatly  weakened  owing  to  any  previous 
disease  or  to  rickets,  the  lame,  the  one  armed,  the  humpbacked  or  crippled  in 
any  other  way,  who  are  unable  to  work,  and  all  those  who  might  become  a 
burden  to  the  State. 

We  hope  that  if  Congress  enacts  said  law,  which,  as  already  stated,  is  under 
consideration,  we  shall  not  only  be  freed  from  some  diseases  unknown  to  us, 
but  by  not  allowing  them  to  be  introduced  in  our  territory,  we  shall  guard  our 
neighboring  countries  against  them. 

I  invite  you,  gentlemen,  to  suggest  to  your  respective  governments  the  ad- 
visability of  taking  similar  precautionary  measures  to  those  we  have  already 
adopted,  or  rather  to  those  which  will  soon  constitute  a  part  of  our  sanitary 
legislation. 

If  all  the  people  of  America  would  form  a  true  league  in  order  to  prevent  the 
entrance  of  sick  immigrants,  or  those  unable  to  work,  in  the  vast  extent  of  our 
continent,  we  would  contribute  in  a  very  efficient  manner  to  improve  both  the 
social  and  sanitary  conditions  of  our  respective  countries. 

I  desire  to  add  a  word  to  what  I  have  read.  Immigrants  are  not  like 
other  passengers.  I  request  very  severe  laws  for  immigrants,  but  not 
for  passengers. 

DR.  ROBERTS.  As  I  had  the  honor  to  state  when  I  read  my  report 
concerning  Cuba,  and  which  I  submitted  to  you,  the  entrance  of  immi- 
grants afflicted  with  trachoma  should  be  prohibited.  Trachoma  is  not 
imported  into  Cuba  from  Asia  by  Chinamen,  because  the  entrance  of 
Chinese  subjects  in  Cuban  territory  is  absolutely  prohibited,  and  there- 
fore, this  disease  can  not  be  brought  in  by  the  Chinese.  On  the  other 
hand,  many  European  immigrants  brought  the  disease  to  Cuba. 

The  quarantine  service  of  Cuba  has  physicians  at  the  Spanish  ports 
whose  duty  it  is  to  examine  persons  afflicted  with  trachoma,  and  thus 
prevent  their  entrance  to  Cuba,  and  it  is  also  their  duty  to  vaccinate 
them,  and  thus  comply  with  that  requisite  of  the  laws  of  the  country, 
and  prevent  smallpox  on  board  the  ships,  a  disease  which  often  occurs 
on  vessels  arriving  in  Cuba. 

Now,  the  mission  of  the  physicians  of  the  quarantine  service  in  Span- 
ish ports,  which  send  us  a  great  current  of  immigration  is,  for  many 


65  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

reasons,  very  difficult  to  carry  out.  In  the  first  place,  at  the  Spanish 
ports  whence  these  immigrants  come,  young  men  embark  who  are  un- 
willing to  render  military  service  in  their  country,  and  illegally  obtain 
permits  to  embark,  and  as  they  have  not  been  examined  by  any  au- 
thority or  physicians,  nor  identified  by  anyone,  some  of  them  who  are 
not  vaccinated  may  be  afflicted  with  trachoma ;  but  in  the  Cuban  ports 
the  sanitary  service  endeavors  to  ratify  the  examinations  made  by  the 
physicians  residing  in  Europe  and  attached  to  the  consulates,  and  they 
ratify  also  the  diagnosis  or  observation  they  have  made. 

When  the  health  officers  visit  a  vessel,  the  physicians  of  the  port 
immediately  proceed  to  vaccinate  persons  who  have  not  been  recently 
vaccinated,  and  while  carrying  out  this  operation,  they  examine  the 
eyes  of  the  immigrants,  and  if  they  detect  in  any  of  them  an  abnormal 
condition  of  the  conjunctivas,  they  make  a  brief  report  without  further 
examination,  and  address  a  communication  to  the  special  commissioner, 
who  causes  the  immigrant  to  be  thoroughly  examined  by  a  special 
commission  of  occulists  whose  diagnosis  is  considered  final. 

If  from  this  examination  it  should  appear  that  the  patient  is  afflicted 
with  trachoma,  he  is  re-embarked  for  the  port  of  origin,  but  if  he  hap- 
pens to  be  a  Cuban,  he  will  be  allowed  to  land. 

As  to  leprosy,  I  would  state  that  it  is  one  of  the  diseases  subject  to 
quarantine  in  Cuba.  A  leprous  person  is  re-embarked  for  the  place  of 
origin,  and  care  is  taken  to  disinfect  in  the  most  thorough  manner  the 
place  occupied  by  him. 

Immigrants  afflicted  with  tuberculosis,  if  they  are  unable  to  work 
and  are  liable  to  become  a  burden  to  the  State,  that  is  to  say,  if  they 
are  in  an  advanced  stage  of  the  disease,  they  are  re-embarked  for  the 
countries  of  origin. 

Persons  afflicted  with  malaria  or  beri-beri  are  admitted,  but  are  sent 
to  hospitals  for  contagious  diseases  until  they  are  cured. 

DR.  FERRER.  Mr.  Chairman,  the  first  case  of  trachoma  in  Chile  oc- 
curred in  1902,  and  the  case  was  discovered  by  Dr.  Maximo  Cienfue- 
gos,  professor  of  ophthalmologic  clinic,  and  since  then,  according  to  the 
detailed  statistics  of  that  same  clinic,  of  1,000  children  afflicted  with 
conjunctivitis,  there  were  only  14  cases  of  trachoma,  and  therefore, 
such  statistics  are  rather  vague,  but  in  spite  of  this  fact,  the  necessary 
precautionary  measures  have  been  taken. 

There  are  physicians  at  Santiago,  Chile,  who  carefully  examine 
children. 

With  regard  to  immigration,  rules  and  regulations  have  been  issued, 
which  are  now  in  force,  and,  besides,  physicians  have  been  sent  to 
Europe,  attached  to  the  consulates,  whose  duties  are  to  examine  all 
passengers  coming  to  our  port,  and,  consequently,  every  immigrant 
coming  to  Chile  is  examined  by  immigrant  physicians. 

Such  immigrants  are  examined  again  in  Chile,  and  therefore,  by 
means  of  this  system,  I  think  we  have  the  guarantee  that  trachoma 
will  not  develop  among  us,  and  I  should  add  that  the  only  cases  that 
have  occurred  were  among  the  Turkish  or  Arabian  immigrants. 

Beri-beri  is  unknown  in  Chile.  Two  or  three  years  ago  a  vessel 
arrived  in  Chile  from  the  Fridge  Islands,  and  the  whole  crew  was  ill 
with  beri-beri,  and  all  of  them  died,  except  a  cook  and  his  assistant, 
who  were  compelled  to  run  the  vessel  aground  on  the  Chilian  coast. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  67 

I  take  advantage  of  this  opportunity  to  inform  the  delegates  of  a 
fact  worth  knowing. 

In  the  steamer  that  brought  me  from  Valparaiso  to  Panama,  a  per- 
son afflicted  with  leprosy  came  on  board  at  one  of  the  ports  at  which 
the  steamer  touched,  to  the  displeasure  of  all  the  passengers,  and  went 
into  the  dining  room.  He  landed  in  a  port  of  the  same.  Republic,  and 
no  precautionary  measures  were  taken  against  him.  When  he  landed. 
I  inquired  whether  the  bedclothes  used  by  said  person  had  been  disin- 
fected, or  whether  any  disinfection  had  been  made,  and  learned  that 
absolutely  nothing  had  been  done.  I  call  attention  to  this  serious  case, 
because  it  should  be  borne  in  mind  by  the  nations  who  had  accepted 
the  Convention  of  Washington. 

THE  CHAIRMAN.  If  no  one  wishes  to  make  any  further  remarks,  I 
beg  to  suggest  the  following  resolution  to  the  Convention : 

It  should  be  recommended  to  the  Governments  represented  at  this  Convention 
to  enact  a  law  prohibiting  the  immigration  of  persons  afflicted  with  trachoma 
or  beriberi  to  each  of  the  respective  countries. 

DR.  ROBERTS.  By  preventing  the  emigration  of  persons  afflicted  with 
trachoma  from  one  country  to  another,  we  actually  prevent  the  intro- 
duction of  trachoma  into  any  nation,  and  as  we  are  here  assembled 
for  a  common  purpose — for  a  Pan-American  purpose — it  seems  to  me 
that  we  should,  at  the  same  time,  devise  means  for  diminishing  the 
number  of  persons  afflicted  with  trachoma,  and  to  this  end  it  would  be 
very  desirable  to  submit  such  patients  to  a  special  inspection  by  the 
local  authorities,  in  order  not  only  to  diminish  the  number  of  said 
patients,  but  also  to  avoid  the  transmission  of  the  disease  to  the  other 
inhabitants  of  the  town. 

THE  CHAIRMAN.  Does  any  of  the  delegates  wish  to  make  any  re- 
marks on  the  subject?  (No  one  desired  to  make  any  further  remarks 
on  the  subject.) 

In  accordance  with  the  resolution  adopted  at  the  first  session,  it 
was  agreed  that  if  one  of  the  subjects  to  be  discussed  at  a  certain  ses- 
sion should  become  exhausted,  we  should  proceed  to  discuss  the  next 
topic  in  the  following  session,  and,  therefore,  I  open  to  discussion  the 
subject  corresponding  to  Friday's  session,  namely,  "Discussion  on  the 
Measures  to  Prevent  the  Transmission  of  Tuberculosis  on  Board  of 
Vessels  and  in  Railroad  Cars."  We  may  say  that  the  subject  of  tuber- 
culosis is  open  to  discussion  the  world  over.  If  at  the  present  sanitary 
convention  it  were  possible  for  us  to  discuss  the  measures  to  pre- 
vent tuberculosis,  it  is  evident  that  we  would  not  have  enough  time  at 
the  sessions  we  have  at  our  disposal — not  even  if  we  should  have  a 
double  number  of  them — to  exhaustively  treat  this  subject.  My  pur- 
pose is  simply  to  request  the  delegates  here  present,  and  to  those  who, 
like  Dr.  Roberts,  have  had  great  personal  experience  in  the  treatment 
of  this  disease,  to  help  me  in  the  study  already  undertaken,  since  we 
do  not  propose  to  introduce  a  novelty,  but  only  to  agree  among  our- 
selves as  to  the  precise  rules  that  should  be  put  in  practice  in  order 
to  prevent  the  spread  of  said  disease  on  board  vessels  and  in  railroad 
cars. 

We  know  positively  that  there  are  two  ways  of  contracting  the  dis- 
ease, namely :  through  the  respiratory  apparatus,  and  through  the 


68  THIRD   INTERNATIONAL    SANITARY    CONVENTION. 

digestive  apparatus.  We  should  not  concern  ourselves  with  the  diges- 
tive apparatus  because  there  are  rules  already  established  and  well 
known  to  the  delegates,  as  for  instance,  the  taking  of  good  food  and 
good  drinks.  Therefore,  it  is  not  necessary  to  establish  any  inspection 
except  on  vessels  where  it  is  really  of  the  greatest  importance  to  in- 
spect the  manner  of  preparing  food  for  the  purpose  of  preventing  the 
transmission  of  tuberculosis.  With  regard  to  railroad  cars,  the  means 
which  have  been  proposed  are  many,  but  I  beg  to  suggest  some  of  them 
because  they  can  be  easily  applied.  I  am  going  to  show  you  an 
apparatus  which  was  constructed  by  a  countryman  of  mine,  and  which 
has  the  following  advantages : 

It  is  a  cuspidor  made  to  be  placed  next  to  each  seat  in  railroad  cars. 
The  cuspidor  is  small  because  they  are  to  be  used  near  the  persons,  but 
it  is  evident  they  could  be  made  larger  if  desired.  The  principal  fea- 
ture of  the  invention  is  that  a  continuous  current  of  water  passes 
through ;  as  soon  as  the  cover  is  lifted  and  one  spits  into  the  cuspidor, 
an  antiseptic  liquid,  such  as  a  solution  of  carbolic  acid,  bichloride  of 
mercury,  lime  water,  or  the  like,  commences  to  flow,  and  drops  into 
an  interior  deposit  in  the  car. 

Another  colleague  of  mine  suggested  to  me  that  perhaps  it  would 
be  better  to  cause  the  sputum  to  fall  on  a  heated  metallic  plate,  heated 
either  by  steam  or  electricity.  In  this  way,  the  sputum,  being  thrown 
on  the  plate,  the  liquid  part  thereof  is  evaporated  while  the  solid  part 
is  consumed. 

I  call  the  attention  of  the  delegates  to  these  suggestions  because  they 
may  induce  other  persons  to  devise  other  means  that  have  not  occurred 
to  me.  Of  course,  we  should  not  forget  the  recommendation  to  thor- 
oughly clean  the  cars,  and  allow  only  those  persons  to  expectorate  who 
have  portable  cuspidors,  require  the  cleaning  of  seats,  and  not  permit 
the  dusting  in  cars  as  is  done  at  present,  not  to  improperly  use  the 
broom,  and  to  clean  the  floor  with  wet  rags,  to  disinfect  the  bedclothes 
used  in  sleepers,  and  periodically  the  coaches  themselves.  I  would  add 
that  these  measures  have  already  been  put  in  practice.  Bedclothes  are 
the  most  apt  to  transmit  any  disease,  and  a  special  recommendation 
must  be  made  concerning  this.  In  American  and  iMexican  coaches, 
these  blankets  are  placed  between  two  sheets,  so  that  the  latter  may  be 
easily  disinfected,  but  perhaps  it  is  not  so  with  regard  to  the  pillow 
cases.  These  are  the  means  which  have  been  suggested  to  me,  and 
I  request  the  delegates  to  point  out  any  other  that  might  occur  to 
them. 

DR.  ROBERTS.  Mr.  Chairman  and  delegates:  In  accordance  with 
the  prophylaxis  of  tuberculosis  on  vessels,  we  have  necessarily  to 
divide  the  latter  in  two  classes,  namely,  ocean  and  coastwise  steamers. 
The  latter,  which  constitute  an  integral  part  of  the  nation,  should  be 
subject  to  the  prophylactic  measures  on  tuberculosis  imposed  by  said 
country,  but  with  regard  to  ocean  steamers,  the  difficulty  for  us  is 
greater,  for  a  very  simple  reason:  each  vessel  has  its  rules  and  regu- 
lations imposed  by  the  nation  to  which  it  belongs,  and  therefore,  said 
vessel  will  not  submit  to  rules  prescribed  by  another  nation.  For  in- 
stance, take  an  Italian,  or  the  vessel  of  any  other  nation,  having  on 
board  Italian  immigrants,  which  is  required  to  have  on  board  a  physi- 
cian for  a  giv^n  number  of  immigrants,  and  to  have  on  board  a  small 


THIRD    INTERNATIONAL    SANITARY   CONVENTION.  69 

dispensary  with  a  special  petitoric.  This  is  done  by  Italy  in  order  to 
protect  its  emigrants,  but  as  we  have  no  emigration,  but  only  immi- 
gration, we  cannot,  therefore,  demand,  and  it  is  almost  impossible  to 
expect  others  to  submit  to  certain  regulations,  which  would  have  to  be 
prescribed  by  the  nation  to  which  the  vessel  belongs  or  to  which  the 
emigrants  belong. 

There  is  no  doubt  that  third  class  passengers  are  most  liable  to  con- 
tract tuberculosis  on  board  vessels,  because  they  live  in  common,  and 
it  seems  to  me  that  it  is  especially  in  that  part  of  the  vessel  where 
the  severest  measures  should  be  enforced,  causing  the  same  to  be  dis- 
infected after  the  landing  of  the  immigrants  who  occupied  it.  These 
immigrants,  who  are  crowded  on  the  vessel  and  poorly  fed,  are  un- 
doubtedly those  who  are  most  liable  to  contract  tuberculosis. 

DR.  VON  EZDORF.  My  idea  on  the  subject  of  tuberculosis  on  vessels 
is  that  we  cannot  take  any  particularly  extraordinary  measures  against 
tuberculosis  in  the  traveling  public ;  but  one  measure  I  think  we  should 
take  in  regard  to  vessels,  and  that  is  the  examination  of  crews,  to  pro- 
vide that  crews  at  least  should  be  free  from  tuberculosis. 

As  for  the  other  measures,  of  course  there  are  always  some  laws  or 
regulations  adopted  to  prohibit  expectoration  in  public  places  or  places 
where  people  congregate,  and  there  should  always  be  regulations  of 
that  kind  on  a  vessel.  There  have  been  a  number  of  suggestions  made 
in  this  connection,  and  one  that  I  have  thought  would  be  applicable,  is 
the  use  of  paraffine  paper  spit  cups  that  could  be  made  in  a  very  cheap 
form  and  might  even  be  distributed  by  means  of  slot  machines,  where 
you  could  get  them  for  probably  a  penny  or  two  pennies,  with  printed 
directions  on  the  machine  how  to  use  the  cup  and  directions  for  its 
disposition  after  it  has  been  used  for  some  time. 

Provision  could  be  made  for  the  destruction  of  the  expectoration  and 
the  cup  at  one  time  by  fire,  which  is  the  best  way  to  disinfect  infected 
expectoration. 

I  have  one  other  proposition  which  I  think  would  be  a  good  one,  and 
that  is  the  screening  of  all  the  living  quarters  of  a  vessel.  I  believe 
that  is  practicable.  It  would  tend  to  protect  the  vessel  against  mos- 
quitoes and  flies. 

On  vessels  the  dining  and  living  quarters  frequently  swarm  with 
flies  come  in  contact  with  infected  expectoration  they  may  deposit 
some  of  the  organisms  or  some  of  this  matter  in  the  food  or  the  milk, 
or  in  any  of  the  edibles,  and  I  believe  that  is  one  way  by  which  tuber- 
culosis may  be  spread.  I  therefore  consider  that  the  screening  of  all 
living  quarters  is  advisable  on  board  a  vessel.  I  had  some  other  points 
on  this  subject  which  I  intended  to  present;  I  did  not  know  it  would 
be  taken  up  this  afternoon. 

DR.  FERRER.  One  of  the  things  that  any  traveler  may  observe  on 
board  a  steamer  is  the  fact  that  napkins  are  not  changed  every  day.  In 
some  steamers  they  change  them  only  on  Sundays,  and  frequently  the 
napkin  which  has  been  used  by  one  person  is  given  to  another.  It 
would  be  advisable  to  follow  the  custom  observed  in  sanitariums, 
namely,  to  place  the  napkins  in  a  waterproof  cover  with  the  name  of 
the  person  thereon.  In  many  cities  it  is  quite  a  common  thing  to  see 
signs  prohibiting  expectoration,  yet,  it  was  in  one  of  the  most  progres- 
sive cities  I  have  visited — where  these  signs  are  used  .and  where  fines 


7O  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

are  imposed  for  the  violation  of  this  rule — that  I  saw  the  greater  num- 
ber of  people  expectorating  on  the  floor.  It  would  be  advisable  to 
devise  some  practical  means  of  compelling  the  observance  of  the  rules 
referred  to  on  these  signs. 

Chilian  railroads  have  made  great  progress  so  far  as  disinfection  is 
concerned,  but  there  is  a  custom  which  should  be  taken  into  considera- 
tion in  the  discussion  of  tuberculosis,  and  that  is  a  war  against  the 
broom  and  the  duster,  which  are  in  common  use  in  our  countries. 

The  program  only  refers  to  measures  against  tuberculosis  on  steam- 
ers and  in  railroad  cars,  but  I  think  we  could  go  beyond  said  program 
and  make  some  other  recommendations,  such,  for  instance,  as  the  one 
proposed  by  Dr.  Soza  in  his  report,  prohibiting  the  employment  of 
consumptive  schoolmasters.  This  has  already  been  prohibited  in  some 
countries,  but  in  many  others  there  are  consumptive  schoolmasters  who 
continue  to  teach.  I  have  made  these  remarks  in  a  brief  manner 
because  I  was  not  prepared  for  this  discussion. 

DR.  GONZALEZ.  On  one  of  my  last  journeys,  I  observed  something 
that  suggested  an  idea  to  me.  By  chance  I  went  to  the  quarters  of 
the  steerage  passengers  at  the  time  the  crew  was  at  dinner,  and  noticed 
that  all  the  members  of  the  crew  were  crowded  together,  and  among 
them  was  one  who  was  evidently  a  consumptive,  All  of  them  took 
their  dinner  in  tin  pails  which  are  washed  in  a  basin  of  dirty  water, 
and  wiped  with  the  same  rag.  Could  we  not  devise  some  beneficial 
measure  for  the  prevention  of  contagion,  by  ordering  the  disinfection 
of  these  utensils  ? 

DR.  ROBERTS.  I  simply  desire  to  make  an  explanation  which  may, 
perhaps,  be  desirable.  We  cannot  legislate  concerning  foreign  vessels, 
but  only  concerning  our  own,  and  the  danger  does  not  lie  in  the  latter, 
but  in  the  former. 

DR.  MENDIZABAL.  With  reference  to  the  question  of  the  prophylaxis 
of  tuberculosis  which  is  being  discussed,  I  regret  to  say  that  we  have 
been  propagating  panic  to  such  an  extent  that  at  present  people  are 
afraid  of  a  person  simply  because  he  expectorates  or  grows  thinner, 
and  in  some  places  this  fear  has  been  carried  to  such  an  extreme  that 
I  know  a  town  where  persons  are  taken  to  the  Police  Court  only  be- 
cause they  find  themselves  in  the  condition  referred  to  above,  and  hotel 
keepers  are  fined  heavily  because  they  allow  people  in  delicate  health 
to  stop  in  their  houses,  and,  what  is  still  worse,  a  fine  of  $50  has  been 
imposed  on  some  people  who  have  expectorated  in  the  street.  There- 
fore, a  kind  of  microphobia  has  been  developed.  I  may  perhaps  be 
told  that  this  fear  is  the  waiting  room  of  prophylaxis,  but  I  would  add 
that  in  my  opinion  it  has  become  a  real  disease,  because  some  persons 
seem  to  be  even  afraid  of  their  own  shadow. 

That  does  not  mean,  of  course,  that  I  am  opposed  to  the  adoption  of 
measures  in  this  case,  because  I  am  one  of  those  who  earnestly  recom- 
mend cleanliness  because  I  consider  it  the  principal  factor  in  life.  It 
is  right  to  prohibit  expectorating  on  the  floor,  because  it  is  dirty  and 
vulgar  to  do  so,  but  we  should  not  frighten  people,  making  them  believe 
that  simply  because  they  pass  near  the  sputum  of  a  person  afflicted 
with  tuberculosis  they  will  be  infected.  Those  of  us  who  have  been 
practicing  medicine  for  thirty  or  forty  years  have  witnessed  three  evo- 
lutions :  there  was  a  time  when  we  did  not  fear  tuberculosis ;  after- 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  /I 

wards  we  commenced  to  fear  that  the  disease  might  be  somewhat 
contagious,  and  we  now  know  that  it  is  highly  contagious,  but  our  fear 
has  not  increased  to  such  an  extent  as  to  be  exaggerated,  because  if 
through  the  sputum  of  a  consumptive,  real  contagion  should  occur, 
many  millions  of  human  beings  would  have  perished  by  this  time.  Our 
lives  are  full  of  fears,  and  we  should  avoid  increasing  them,  besides,  it 
is  really  very  painful  and  sad  to  see  society  a  victim  of  fear. 

A  new  doctrine  is  now  being  advocated,  and  seems  to  prevail  in 
Europe,  namely,  that  contagion  cannot  be  acquired  through  the  respira- 
tory organs,  and  lately  Behring's  works,  and  still  later  those  of  Clem- 
ent, have  demonstrated  that  the  greater  number  of  infections  have 
been  acquired  through  the  digestive  organs.  Therefore,  we  are  now 
able  to  see  that  we  should  not  fear  an  expectoration  which  the  rays 
of  the  sun  will  destroy,  and  that  we  should  not  be  so  much  afraid  to 
stay  in  a  railroad  car  where  it  will  be  sufficient  to  open  the  windows 
and  let  in  the  air  and  the  sun  in  order  to  disinfect  it  in  a  more  thorough 
manner  than  could  possibly  be  done  by  all  the  antiseptics  known  in 
the  world. 

Gentlemen :  We  all  know;  because  we  have  traveled  a  great  deal 
by  rail  in  the  United  States,  for  instance,  that  the  trains  there  lack 
light  and  air,  which  are  without  doubt  the  best  disinfectants  that  we 
have,  and  which  have  been  granted  us  by  Divine  Providence.  Now, 
then,  I,  in  the  name  of  humanity,  inasmuch  as  we  are  here  assem- 
bled to  discuss  humanitarian  questions,  request  you  to  be  a  little 
more  humane  and  kind  to  those  unfortunate  consumptives.  If  they  do 
not  cause  us  as  much  harm  as  it  is  supposed,  and  if  we  know  that  the 
person  who  enjoys  good  health  and  is  well  fed  has  nothing  to  fear, 
because  we  have  seen  many  healthy  and  strong  persons  who  have  been 
in  close  contact  with  persons  afflicted  with  tuberculosis,  why  should 
we  then  entertain  such  fears?  Would  any  of  us  tolerate,  when  trav- 
eling, accompanied  by  his  wife,  that  she  should  be  ordered  to  leave 
the  train  simply  because  she  was  supposed  to  be  afflicted,  or  even 
though  she  was  really  afflicted  with  tuberculosis? 

Let  us  then  be  humane,  and  adopt  all  the  measures  proposed,  which 
I  cheerfully  accept,  but  let  us  also  avoid  the  spreading  of  panic,  by 
putting  before  the  people  an  invisible  enemy  which  causes  great  fear. 

THE  CHAIRMAN.  The  hour  for  adjournment,  in  accordance  with  the 
rules  of  the  Conference,  having  arrived,  should  any  delegate  desire  to 
make  any  remarks,  he  can  do  so  at  the  next  session. 

The  session  adjourned. 


72  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 


FIFTH  DAY,  FRIDAY,  DECEMBER  6. 
Morning  Session. 

The  session  was  called  to  order  by  the  Chairman,  Dr.  Liceaga,  at 
9  a.  m.,  the  following  delegates  being  present:  Doctors  Oswaldo 
Gongalvez  Cruz,  Ricardo  Gutierrez  Lee,  Genaro  Payan,  Hugo  Roberts, 
Juan  Guiteras,  Ernesto  Soza,  Pedro  L.  Ferrer,  Juan  Horacio  Estevez, 
Walter  Wyman,  R.  H.  von  Ezdorf,  P.  T.  Straub,  James  Gatewood, 
Rhett-Goode,  H.  L.  E.  Johnson,  Salvador  Ortega,  Jose  Azurdia,  Luis 
Lazo  Arriaga,  Gregorio  Mendizabal,  Rodolfo  B.  Gonzalez,  Ernesto  F. 
Espiro,  and  Juan  J.  Ulloa,  Secretary. 

The  minutes  of  the  previous  session  being  read  and  approved,  the 
delegates  of  Costa  Rica,  of  Uruguay,  Brazil,  and  Chile,  proposed,  in 
the  name  of  their  respective  Governments,  the  capitals  of  their  respec- 
tive countries  as  the  place  in  which  to  hold  the  next  international  sani- 
tary conference,  and  these  propositions  were  referred  to  the  Advisory 
Committee. 

THE  CHAIRMAN.  In  accordance  with  the  resolutions  adopted  at  the 
last  session,  we  will  now  continue  the  discussion  of  the  measures  con- 
cerning international  sanitary  police  for  preventing  the  transmission 
of  tuberculosis  on  board  vessels  and  railroad  cars,  and  to  that  end  Dr. 
von  Ezdorf  continues  to  have  the  floor,  and  will  read  an  address  which 
he  did  not  have  with  him  at  yesterday's  session. 

DR.  EZDORF.  I  should  like  to  conclude  what  I  had  to  say  in  regard 
to  the  transmission  of  tuberculosis  from  individuals  on  board  vessels. 
I  mentioned  yesterday  the  advisability  of  having  paraffine  paper  cups 
provided  on  board  ship  and  also  the  screening  of  the  vessel,  as  practical 
measures. 

In  regard  to  vessels  carrying  passengers,  we  have  to  divide  the  ships 
into  two  classes.  We  have  ships  that  carry  a  large  number  of  persons, 
immigrants,  etc.,  and  others  that  simply  carry  cabin  passengers,  first 
and  second  class  passengers.  We  also  have  ships  which  make  only  short 
voyages,  and  other  ships  that  make  long  voyages,  so  that  we  have  to 
discuss  each  one  of  these  separately. 

Now  in  regard  to  persons  on  board  the  ship  that  is  carrying  a  large 
number  of  passengers :  I  think  one  of  the  first  measures  that  we  have 
to  consider  is  that  they  should  be  educated  to  understand  that  the  prac- 
tice of  expectorating  promiscuously  in  places  frequented  by  others  may 
be  dangerous  to  their  fellow  men.  I  think  every  one  will  agree  to  that, 
that  expectoration  is  a  filthy  habit.  The  second  proposition  is  that  all 
persons  should  be  encouraged  to  use  individual  drinking  cups,  and  also 
cheap  paraffine  paper  cups  might  be  provided  for  use  as  expectorating 
cups — individual  cups. 

Now,  a  point  that  I  wish  to  make  in  regard  to  the  third  class  pas- 
sengers, or  steerage  passengers,  whom  Dr.  Roberts  referred  to  as  being 
the  most  dangerous  individuals  on  board  the  vessels  and  more  likely 
than  the  other  classes  to  infect  the  living  Quarters,  because  of  lack  of 
ventilation  and  lack  of  care — is  that  the  only  provision  we  could  make 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  73 

in  regard  to  those  passengers  is  to  endeavor  to  have  them  understand 
that  they  must  not  expectorate  any  where  except  in  the  places  provided 
for  that  purpose,  and  one  of  the  most  practical  measures  that  I  think 
could  be  adopted  on  board  ship  is  the  use  of  the  paraffine  paper  cup  al- 
ready mentioned,  to  be  placed  folded  into  a  tinform  which  might  hang 
along  the  sides  of  the  bunks.  As  we  know,  these  large  steerage  passen- 
ger vessels  are  very  crowded,  and  the  passengers  are  in  bulks  one 
over  the  other,  sometimes  in  tiers  of  three.  These  cups  can  be  used 
in  cases  of  seasickness  and  for  all  ordinary  expectoration.  I  think 
that  is  all  we  can  possibly  do  with  regard  to  that  class  of  passengers. 

These  cups  could  be  destroyed  by  fire,  or  thrown  overboard  at  sea. 
That  is  practicable  for  any  vessel,  whether  a  long-trip  or  a  short-trip 
vessel. 

But  with  regard  to  a  long-trip  vessel  where  the  passage  is,  say,  two 
or  three  or  four  weeks,  I  think  there  should  be  a  disinfection  of  those 
quarters  or  barracks  of  the  steerage  passengers  at  the  end  of  each 
voyage. 

With  regard  to  the  short-trip  vessels,  where  the  passengers  are  in 
these  steerage  barracks  for  only  two,  three  or  four  days,  I  think  that 
periodical  disinfection  would  be  quite  sufficient. 

Whatever  measures  we  wish  to  adopt  should  be  practical  and  easy  of 
application,  and  these  have  occurred  to  me  as  the  most  practical  and 
easily  understood  by  the  steerage  passengers  that  we  have  to  deal  with. 

As  far  as  the  cabin  passengers  are  concerned,  I  think  they  can  under- 
stand instructions,  wherever  they  may  be  placed  in  printed  form  about 
the  cabins.  I  conclude  this  exposition  with  the  following  conclusions : 

1.  The  traveling  public  should  be  educated  to  understand  that  the  practice  of 
expectorating  promiscuously  about  in  places  frequented    by    persons    may    be 
dangerous  to  his  fellow-man.     Expectoration  is  a  filthy  habit  and  should  be 
made  punishable. 

2.  All  persons  should  be  encouraged  to  use  individual  drinking  cups  and  cheap 
paper  paraffined  cups  should  be  provided  on  all  vessels  for  passengers. 

3.  Disinfection  of  vessels  and  furnishings  of  short-trip  vessels  periodically. 
Disinfection  of  steerage  passenger  barracks  at  end  of  each  voyage  if  the  voyage 
has  been  a  longer  one. 

4.  Notices  should  be  posted  in  steerage  quarters  and  living  quarters  enjoining 
passengers  not  to  expectorate  on  floors. 

5.  Crews  of  vessels  should  be  examined  physically  before  being  given  employ- 
ment. 

6.  Screening  as  far  as  practicable  the  kitchen,  dining  rooms  and  all  living 
quarters  as  a  protection  against  flies. 

7.  Whenever  paraffined  paper  cups  are  provided,  printed  instructions  should 
be  printed  on  cups  as  to  use  and  destruction. 

DR.  SOZA.  Mr.  Chairman:  The  Chilean  Delegation,  in  accordance 
with  the  provisions  of  the  provisional  program,  which  requires  that 
each  delegate  shall  give  his  opinion  as  to  the  manner  of  preventing 
the  transmission  of  tuberculosis  on  railroad  cars  and  vessels,  has 
deemed  it  advisable  to  submit  to  the  consideration  of  this  Conference 
the  following  recommendations: 

PROPHYLAXIS  OF  TUBERCULOSIS  ON  RAILROAD  CARS  AND  STEAMERS. 

I.  To  avoid,  as  far  as  possible,  in  dormitories  the  use  of  fixed  carpets  and 
curtains. 


74  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

2.  To  recommend  the  use  of  cuspidors  which  should  be  profusely  distributed. 

3.  The  periodical  disinfection  of  cars  or  berths,  including  furniture,  beds,  etc. 

4.  The  disinfection  of  dining  room  utensils.    In  the  dining  rooms  of  steamers 
where  napkins  are  not  changed  after  each  meal,  the  napkins  shall  be  kept  in 
special  envelopes. 

5.  The  examination  of  the  personnel  and  rejection  of  persons  suspected  of 
being  afflicted  with  tuberculosis. 

6.  Notices  posted  in  conspicuous  places  which  shall  read : 

TO  SPIT  ON  THE  FLOOR  IS  A  FILTHY  AND  IMPOLITE  HABIT 
WHICH  OFTEN  CAUSES  THE  SPREAD  OF  CONTAGIOUS  DIS- 
EASES. 

DR.  JOHNSON.  Mr.  President  and  members  of  the  Convention:  In 
accordance  with  the  preliminary  programme,  I  have  the  following  com- 
ments to  make  with  respect  thereto : 

We  recommend  to  the  several  American  Republics  that  they  take  the  necessary 
steps  toward  the  codification  of  all  the  Health  Laws  and  Regulations,  both  statute 
and  police,  and  present  the  same  to  the  Bureau  of  American  Republics  at  Wash- 
ington. The  ultimate  object  being  the  unification  of  all  such  laws  and  regula- 
tions. 

(This  motion  was  referred  to  the  Advisory  Committee.) 

DR.  LAZO  ARRIAGA.  I  have  heard  with  pleasure  the  opinion  ex- 
pressed concerning  the  prophylaxis  of  tuberculosis  on  steamers  and 
railroad  cars.  I  think  that  all,  or  at  least  the  majority  of  us,  accept 
the  means  suggested  for  that  purpose,  and  that  the  principal  and  almost 
the  only  one  that  could  be  put  in  practice  is  cleanliness ;  but  it  seems 
to  me  that  we  should  not  put  difficulties  in  the  way  of  those  afflicted 
with  tuberculosis  who  desire  to  travel,  or  to  prevent  them  from  doing 
so,  because,  what  would  be  said  of  a  physician  who  would  tell  his 
patient,  you  can  not  be  cured?  What  would  be  said  of  a  physician 
who  would  say  to  his  patient :  You  have  such  and  such  a  disease  ?  It 
would  be  an  injury  to  the  patients,  and  yet  that  is  just  what  we 
would  be  doing  by  excluding  from  steamers  and  railroad  cars  per- 
sons afflicted  with  tuberculosis. 

We  were  told  yesterday  that  the  greatest  difficulty  in  transporting 
the  sick  was  among  second  class  and  steerage  passengers.  I  do  not 
agree  with  this  view  of  the  matter.  The  poor  afflicted  with  tuberculosis 
do  not  travel,  not  only  because  they  can  not  afford  it,  but  because  they 
do  not  desire  to  do  so,  and  those  traveling  as  emigrants  are  look- 
ing for  work  and  not  for  health.  The  sick  who  travel  for  the  benefit 
of  their  health  are  the  rich,  that  is  to  say,  those  who  can  pay  first 
class  passage,  and  they  will  have  a  physician  on  board  who  will  sug- 
gest to  them  the  necessary  means  not  to  endanger  the  health  of  the 
other  passengers.  As  I  said  before,  it  is  not  proper  to  reject  such 
passengers,  but  to  subject  them  to  the  observance  of  certain  rules,  and 
to  prevent  them  from  knowing  that  they  are  seriously  ill. 

With  regard  to  steerage  passengers,  and  I  make  this  as  a  motion,  I 
think  the  steamship  companies  should  be  requested  to  treat  the  sick 
as  they  are  treated  in  hospitals.  Many  a  time  it  is  not  poverty  that 
abounds  so  much  in  the  lower  decks  of  vessels  as  it  is  filthiness ;  people 
who  are  starving  do  not  go  there;  the  danger  lies  in  filth,  and  the 
steamship  companies  might  compel  passengers  upon  receiving  them 
on  board  to  take  a  bath ;  they  might  furnish  them  with  a  special  dress 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  75 

for  the  voyage,  cause  their  clothes  to  be  washed  and  disinfected,  de- 
livering the  same  to  them  at  the  place  of  landing.  I  believe  this  would 
be  a  beneficial  measure  both  to  the  passengers  and  to  the  country. 

DR.  AZURDIA.  On  board  the  steamer  on  which  I  came  to  this  city 
with  Dr.  Ortega,  one  of  the  passengers  had  a  hemoptysis  which  en- 
dangered his  life.  We  had  occasion  to  assist  him,  and  we  observed  that 
the  physician  on  board  the  steamer  paid  absolutely  no  attention  to  that 
very  important  disease. 

Fortunately,  the  patient  recovered  from  the  hemoptysis  in  spite  of 
the  indifference  shown  by  the  physician  on  board  the  steamer,  but  it 
seems  to  me  that  it  would  be  worth  while  for  the  Convention  to  recom- 
mend to  the  different  governments  to  require  that  the  physicians  em- 
ployed on  board  steamers  be  duly  qualified,  and  to  have,  in  addition, 
some  knowledge  of  contagious  and  infectious  diseases,  and  to  be  able 
to  advise  the  necessary  prophylactic  measures  that  should  be  taken 
in  order  to  protect  healthy  persons  from  all  danger  of  contagion. 

Therefore,  I  believe  that  it  would  be  worth  while  to  recommend 
this  matter  to  the  Governments  of  the  American  Republics. 

THE  SECRETARY.  I  am  going  to  make  a  motion,  in  order  to  save  time. 
Good  scientific  measures  have  been  proposed,  based  on  a  knowledge 
of  tuberculosis,  and  also  on  the  experience  of  physicians,  in  order  to 
prevent  the  spread  of  this  disease  on  railroad  cars  and  steamers. 

Fortunately  almost  all  the  delegates  agree  as  to  the  majority  of  the 
measures  submitted,  and,  consequently,  I  move  that  Dr.  Soza,  delegate 
of  Chile,  and  a  specialist  in  the  matter,  be  requested  to  collect  all  the 
opinions  and  condense  in  one  single  proposition  all  the  measures  re- 
sulting from  the  different  resolutions,  in  order  to  submit  said  proposi- 
tion to  the  -consideration  of  the  Committee  on  Tuberculosis. 

DR.  GUTIERREZ  LEE.  I  entirely  agree  with  all  that  has  been  pro- 
posed concerning  the  practical  measures  against  tuberculosis,  but  it 
seems  to  me  that  it  is  necessary  to  do  something  more.  I  would  advise 
as  an  additional  measure  concerning  the  prophylaxis  of  tuberculosis 
that  on  all  newly  constructed  railroad  cars  and  steamers,  there  shall 
be  provided  a  special  place  for  the  accommodation  of  consumptives. 
At  present  we  find  that  in  ordinary  cars  two  or  three  sick  persons  may 
travel,  and  if  the  cars  that  are  to  be  constructed,  because  progress  has 
to  sanction  modern  sanitary  measures,  a  special  department  should 
be  established,  that  is  to  say,  an  infirmary  for  persons  suspected  of  being 
afflicted  with  tuberculosis,  I  think  good .  results  would  be  obtained. 
Formerly  there  were  cars  on  which  travelers  were  exposed  to  the 
inclemency  of  the  weather,  but  at  present  we  find  that  railroad  cars 
have  berths,  dining  rooms  and  sitting  rooms.  Therefore,  I  believe  that 
it  would  be  an  easy  matter  to  secure  special  cars  for  the  accommo- 
dation of  patients,  since  otherwise,  if  proper  attention  is  not  given 
to  the  unfortunate  consumptives,  we  would  revert  to  the  usages  of  the 
Middle  Ages  when  legislation  was  so  severe  that  patients  were  seized 
in  their  own  houses,  and  even  their  property  was  taken  away  from 
them.  I  have  read  in  a  certain  book  that  when  leprosy  prevailed  in 
England  and  Germany,  those  afflicted  with  that  disease  were  not 
allowed  to  go  into  the  street  and  their  property  was  taken  from  them. 
In  fact  they  did  everything  short  of  shooting  them. 

I  think  that  we  should  try  to  devise  means  of  avoiding  diseases,  but 


76  THIRD    INTERNATIONAL   SANITARY   CONVENTION. 

in  such  a  way  that  the  patients  may  have  such  liberty  of  action  as  it 
would  be  inhuman  to  deprive  them  of.  If  a  person  afflicted  with 
cachexy,  for  instance,  a  Frenchman  or  a  Spaniard,  residing  in  Vera 
Cruz,  wishes  to  return  to  his  country,  he  faces  two  propositions ;  either 
the  steamship  company  admits  him  in  spite  of  his  disease,  or  he  is 
detained  by  the  physician  who  acts  as  an  .intermediary  between  the 
company  and  the  people.  In  this  way  the  patient  is  deprived  of  his 
desire  to  die  in  his  country,  or  of  the  hope  of  being  cured  there. 
Should  the  steamship  and  railroad  companies  have  a  complete  infirmary 
then  the  patient  would  be  able  to  travel  and  the  companies  would  be 
able  to  transport  him.  Therefore,  we  should  not  be  inhuman ;  science 
should  be  charitable,  and  should  not  deprive  a  person  carrying  the 
germs  of  a  disease,  the  virulence  of  which  we  do  not  yet  know,  of 
his  freedom  of  action.  This  would  be  equivalent  to  the  provoking  of 
a  social  revolution. 

THE  CHAIRMAN.  The  motion  made  by  Dr.  Ulloa  to  the  end  that  the 
opinions  expressed  heretofore  be  referred  to  Dr.  Soza,  so  that  he  may 
make  a  summary  of  the  same  and  submit  it  to  the  proper  committee, 
is  now  under  discussion.  Does  any  one  wish  to  make  any  remarks? 
Shall  it  be  approved?  The  motion  is  approved. 

DR.  MENDIZABAL.  I  have  requested  the  floor  simply  to  make  some 
remarks,  in  addition  to  what  I  said  yesterday,  on  tuberculosis.  I  am 
very  glad  that  Dr.  Gutierrez  Lee  approves  the  humanitarian  measures 
I  took  the  liberty  to  suggest,  because  I  still  believe  that  the  most  advi- 
sable means  are  the  most  efficient  in  case  of  a  disease  the  transmis- 
sibility  of  which  is  comparatively  small.  Therefore,  we  should  proceed 
with  great  circumspection  and  care,  since  otherwise  I  think  the  unfor- 
tunate consumptives  would  have  to  announce  their  advent  by  the  ring- 
ing of  bells,  so  that  everybody  could  avoid  them  as  they  pass  by. 

I  desire  again  to  call  attention  to  the  difficulties  of  the  modern  sys- 
tem of  navigation,  and  the  necessity  and  advisability  of  adopting  a 
common  sanitary  law,  since  otherwise  we  would  have  to  encounter  the 
greatest  of  difficulties.  I  beg  to  mention  an  instance.  On  the  large 
and  good  Chilean  steamer  in  which  I  made  my  last  voyage,  there  was  a 
physician,  a  medical  student,  who  knew  nothing  about  medicine.  There 
were  many  passengers  on  board,  and  the  quantity  of  merchandise  was 
such  that  it  was  stored  in  the  quarters  reserved  for  steerage  passengers, 
and  the  latter  mixed  with  cabin  passengers.  The  steamer  had  touched 
at  several  places  infected  with  bubonic  plague,  and,  in  spite  of  this  fact, 
everybody  was  allowed  to  freely  visit  the  vessel,  and  to  come  on  board 
and  sell  their  wares  to  passengers,  such,  for  instance,  as  Panama  hats, 
not  stopping  to  think  that  perhaps  some  of  those  who  came  on  board 
had  slept  in  the  same  room  occupied  by  a  person  afflicted  with  the 
bubonic  plague.  There  was  not  on  the  vessel  even  a  poor  quality  of 
vaccine  to  resort  to  in  case  of  necessity.  These  dangers  could  be  avoid- 
ed if  we  would  .adopt  a  general  sanitary  law,  since  then  everybody 
would  doubtless  take  the  proper  precautionary  measures. 

We  arrived  at  a  port  in  Ecuador,  Guayaquil,  where  there  was  no 
lazaretto,  nor  any  other  suitable  place  for  the  isolation  of  the  sick, 
and  inasmuch  as,  for  this  reason,  passengers  were  not  allowed  to  land, 
it  happened  that  several  of  them  who  were  going  to  Peru  were  com- 
pelled to  go  to  Panama  and  thence  continue  their  voyage.  These 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  77 

difficulties  could  be  remedied  by  a  law  to  which  all  of  us  would  have  to 
submit.  The  only  law  now  in  force  is  that  of  the  Convention  of  Wash- 
ington. 

There  is  a  maxim  which  says  that  the  desire  to  obtain  the  best 
thing  possible,  some  times  prevents  the  attainment  of  a  good  thing. 
If  we  have  something  that  is  not  very  good,  let  us  adopt  that  which  is 
the  best  that  we  could  possibly  obtain,  even  though  it  may  not  be  the 
best. 

With  reference  to  tuberculosis,  I  said  that  traveling  is  becoming 
so  difficult  that  it  will  be  necessary  to  have  special  trains,  such  as  they 
now  have  in  the  United  States  for  colored  people,  who,  because  they 
have  thick  lips  and  kinky  hair,  it  is  believed  that 

THE  CHAIRMAN.  I  beg  to  remind  Dr.  Mendizabal  that,  in  accordance 
with  the  rules  adopted,  the  speakers  can  only  have  the  floor  for  five 
minutes. 

DR.  FERRER.  The  remarks  made  by  Dr.  Mendizabal  concerning 
navigation  on  the  Pacific  are  true.  There  is  no  sanitary  service  on 
board  the  steamers.  I  remember  having  been  obliged  to  rise  very  early 
one  morning  in  order  to  attend  some  passengers  because  the  physician 
on  board  did  not  know  what  to  do.  As  this  is  a  question  affecting  the 
national  honor,  it  is  my  duty  to  state  that  Chilean  medical  students  are 
not  to  be  found  on  all  Pacific  coast  steamers. 

What  is  said  of  Ecuador  concerning  this  matter,  is  true,  as  the  rep- 
resentative of  that  country  will  admit,  but  it  should  also  be  said  that 
there  was  a  floating  lazaretto  at  the  port  of  Guayaquil,  which  lazaretto 
was  wrecked,  and  a  new  one  is  now  being  constructed,  though  of  a 
provisional  character. 

Yesterday  I  mentioned  the  fact  that  some  countries  allow  persons 
afflicted  with  leprosy  to  embark  for  foreign  ports,  but  do  not  allow 
them  to  travel  from  one  port  to  another  within  the  country. 

DR.  WYMAN.  Mr.  President  and  Members  of  the  Convention:  In 
accordance  with  the  preliminary  programme,  I  have  the  following  com- 
ments to  make  with  respect  thereto: 

1  have  a  resolution  to  offer — not  on  this  subject,  however.  I  would 
like  to  inquire  if  it  is  pertinent  or  the  proper  time  to  introduce  it. 

Whereas,  It  was  declared  by  the  Third  International  Conference  of  American 
States  held  at  Rio  Janeiro  in  August,  1906,  that  the  Sanitary  Convention  should 
resolve  upon  the  following,  viz: 

The  establishment  of  relations  between  the  International  Sanitary  Bureau 
now  existing  in  Washington  and  the  Bureau  Sanitaire  de  Paris,  in  order  to 
obtain  the  best  information  on  Sanitary  subjects  and  to  reach  agreements  that 
will  facilitate  the  objects  with  which  both  offices  are  established,  and 

Whereas,  the  said  Bureau  Sanitaire  International  de  Paris,  though  not  yet 
established,  will  be  established  in  the  near  future. 

Resolved,  That  the  International  Sanitary  Bureau  at  Washington  is  author- 
ized to  take  such  measures  as  may  be  necessary  to  carry  out  the  Instructions 
contained  in  the  aforesaid  resolutions  of  the  Third  International  Conference  of 
American  States  held  at  Rio  Janeiro  in  August,  1906. 

THE  CHAIRMAN.  Let  it  be  referred  to  the  Advisory  Committee. 
DR.  GATEWOOD.     Mr.  President,  I  desire  to  present  the  following 
resolution,  with  a  request  for  reference  to  the  Advisory  Committee : 

Resolved,  That  the  Sanitary  Conference  recommend  the  establishment  of  sep- 


78  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

arate    hospitals   or    special   wards    for   the    care   or   treatment   of   tuberculosis 
patients. 

DR.  ROBERTS.  I  request  the  floor  in  order  to  present  the  two  fol- 
lowing propositions: 

The  undersigned  states  that,  inasmuch  as  both  the  railroads  and  the  steamers 
constitute  an  integral  part  of  the  nation  to  which  they  belong,  such  prophylactic 
measures  as  are  adopted  on  said  railroads  and  steamers  to  avoid  the  spread  of 
tuberculosis,  should  be  the  same  as  those  for  hotels,  boarding  houses,  etc.,  in 
the  nation  to  which  said  railroads  and  steamers  belong. 

Inasmuch  as  the  object  of  the  Conventions  of  the  American  Republics  is  to 
unite  the  quarantine  processes  in  order  to  protect  public  health,  causing  the  least 
possible  injury  to  international  commerce,  and 

Whereas,  owing  to  the  lack  of  uniformity  of  the  bills  of  health  issued  in  the 
different  American  nations,  it  is  difficult  to  form  an  exact  opinion  concerning 
the  same,  because  they  often  fail  to  furnish  all  the  necessary  details,  I,  there- 
fore, beg  that  the  following  propositions  be  adopted: 

1.  That  in  the  next  meeting  of  the  International  Sanitary  Congress  the  model 
forms  of  the  documents  to  be  used  by  the  nations  accepting  the  Convention,  be 
discussed  and  approved  in  order  to  render  uniform  said  documents. 

2.  That  in  every  port  open  to  foreign  commerce,  the  sanitary  authorities  shall 
issue  bills  of  health  to  all  vessels  applying  for  same,  in  accordance  with  model 
form  adopted  by  the  next  Convention. 

THE  CHAIRMAN.  Let  this  resolution  be  referred  to  the  Advisory 
Committee. 

DR.  FERNANDEZ  ESPIRO.  In  the  brief  exposition  I  had  the  honor  to 
make  last  night  concerning  the  International  Sanitary  Convention  of 
Paris,  or,  in  other  words,  to  that  of  Washington,  which  has  been  based 
on  the  former,  I  expressed  the  opinion  which  I  entertained  regarding 
a  certain  clause  of  that  International  treaty.  Therefore,  in  accordance 
with  said  views,  I  have  thought  that  this  Convention  might  do  a  good 
work  on  meeting  again,  if  it  should  endeavor  to  make  such  amendments 
as  may  be  deemed  advisable  at  said  Convention  of  Washington,  with- 
out prejudice  to  recognizing  the  merit  of  its  work,  and  the  noble  ends 
which  have  guided  the  persons  who  participated  therein.  I  believe 
that  a  committee  could  be  entrusted  with  the  duty  of  formulating  a  plan 
of  sanitary  agreement  of  the  Republics,  and  to  submit  the  same  at  the 
next  Convention. 

This  opinion  is  shared  by  the  delegate  of  the  Republic  of  Brazil, 
and  in  the  name  of  the  country  which  has  sent  me  here,  I  am  going 
to  make  a  motion  to  the  Convention,  hoping  that  it  may  be  favorably 
received  by  the  delegates. 

This  brief  motion  is  as  follows: 

The  delegates  of  Uruguay  and  Brazil  propose: 

1.  That  the  Convention  appoint  a  committee  for  the  purpose  of  presenting  a 
plan  of  an   International   Sanitary  Convention   of  the  American   Republics  to 
become  effective  upon  the  expiration  of  the  Convention  of  Washington,   said 
plan  to  be  considered  by  the  Fourth  Convention. 

2.  The  Commission  appointed  shall   forward  said  plan   to  the  Chairman  of 
the  International  Sanitary  Office  at  Washington,  in  order  that  said  Chairman 
shall    in  turn,  take  the  necessary  steps  so  that  it  may  be  known  in  advance  by 
the  Governments  of  the  American  States. 

The  latter  part  of  the  motion  tends  to  overcome  the  inconveniences 
and  difficulties  encountered  when  the  work  is  not  made  known  before- 
hand to  the  Governments  invited  to  attend  these  conventions. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  79 

THE  CHAIRMAN.  The  motion  made  by  Drs.  Fernandez  Espiro  and 
Gongalvez  Cruz  is  referred  to  the  Advisory  Committee. 

In  order  to  make  the  best  possible  use  of  the  short  time  at  our  dis- 
posal, and  in  accordance  with  the  agreement  made  at  the  first  session, 
the  consideration  of  the  modifications  made  in  the  frontier  ports  and 
cities  in  the  different  countries,  is  now  in  order. 

We  have  a  very  short  time  now,  so  that  the  reading  of  any  report 
concerning  what  the  Mexican  Government  has  done  would  take  all  the 
time  of  the  session.  In  order  that  the  reading  may  be  as  short 
as  possible,  and  that  it  may  be,  at  the  same  time,  instructive,  I  have 
caused  an  album  to  be  placed  in  the  hall  containing  views  of  the  drain- 
age and  water  supply  works  which  have  been  constructed  in  the  ports 
of  Veracruz,  Coatzacoalcos,  Salina  Cruz,  Manzanillo  and  Mazatlan, 
as  well  as  views  of  the  sanitary  stations  in  Veracruz,  Salina  Cruz,  etc. 
On  the  maps  placed  on  the  blackboards  will  be  found  the  complement  of 
these  works. 

I  have  only  mentioned  the  improvement  made  at  the  ports,  and  if  I 
had  time  I  would  call  attention  to  those  that  have  been  made  in  the 
States  of  the  interior  of  the  Republic,  whose  authorities  have  sent 
here  the  plans  and  drawings  of  the  works.  These  documents  are  on 
exhibition  in  the  next  room. 

I  shall  only  read  the  report  made  by  the  Mexican  delegation  in  which 
are  set  forth  the  expenses  incurred  on  account  of  said  works.  (See 
Appendix,  page  186.) 

DR.  FERNANDEZ  ESPIRO.  I  have  listened  with  pleasure  to  the  re- 
port just  read  by  the  Chairman  of  the  Convention  concerning  the  im- 
portant sanitation  works  carried  out  in  the  Mexican  Republic.  In 
conformity  with  the  opinion  of  all  the  delegates,  I  beg  to  propose  that 
the  favorable  impression  which  the  perusal  of  said  report  has  afforded 
us,  be  forwarded  to  the  Government  of  the  Republic  of  Mexico  through 
the  Chairman  and  Secretary  of  the  Convention. 

THE  SECRETARY.  I  second  the  motion  of  Dr.  Fernandez  Espiro. 

THE  CHAIRMAN.  I  gratefully  accept  the  suggestion  made  by  the 
delegate  of  Uruguay,  and  seconded  by  that  of  Costa  Rica,  and  shall 
take  pleasure  in  making  it  known  to  the  Government. 

DR.  FERNANDEZ  ESPIRO.  I  desire  that  it  be  by  a  vote  of  all  the  dele- 
gates, saying  that  the  Convention  hereby  expresses  the  great  pleasure 
with  which  it  has  listened  to  the  reading  of  the  report  of  Dr.  Liceaga, 
and  desires  that  said  manifestation  be  made  known  to  the  President  of 
the  Republic. 

The  motion  was  unanimously  carried. 

THE  CHAIRMAN.  I  once  more  thank  you  for  this  honor. 

DR.  FERRER.  Inasmuch  as  several  motions  have  been  presented  con- 
cerning matters  which  should  be  submitted  to  the  consideration  of  the 
next  Convention,  it  seems  to  me  that  it  would  be  advisable  to  appoint 
a  special  committee  to  make  a  report  to-morrow  on  the  matter,  or  that 
the  committee  kindly  submit  a  complete  plan  so  that  we  may  have  a 
basis  in  order  to  consider  these  matters  at  the  next  Convention. 

DR.  GUITERAS.  I  request  the  floor  in  order  to  state  that  Dr.  Ferrer's 
motion  is  of  a  dual  character,  and  I  believe  this  matter  should  be  re- 
ferred to  the  Advisory  Committee. 


8O  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

THE  CHAIRMAN.  I  agree  with  Dr.  Guiteras,  since  there  would  be  no 
time  to  appoint  the  committee  suggested  by  Dr.  Ferrer.  Therefore, 
the  matter  is  referred  to  the  Advisory  Committee. 

DR.  MENDIZABAL.  As  I  said  in  the  previous  session,  I  believe  that 
the  subject  referring  to  syphilis  and  other  venereal  diseases,  which 
cause  such  great  ravages  to  mankind,  should  be  discussed  at  the  next 
convention. 

Therefore,  I  beg  to  make  the  following  motion: 

Whereas  syphilis  and  other  venereal  diseases  wtiich  at  present  may  be  called 
the  modern  plague,  cause  such  great  ravages  to  modern  society,  degrading  the 
human  race,  predisposing  to  the  contraction  of  many  other  diseases,  the  delegate 
of  the  Republic  of  Nicaragua  submits  to  the  consideration  of  the  Convention, 
the  following  propositions: 

First.  Let  the  question  of  the  uniformity  of  the  means  of  defense  which  each 
country  should  take  in  order  to  prevent  the  spread  of  syphilis  and  other  venereal 
diseases  be  recommended  to  the  consideration  of  the  next  International  Sanitary 
Convention  of  the  American  Republics. 

Second.  Let  these  diseases  be  included  in  the  list  of  diseases  like  yellow  fever, 
bubonic  plague,  cholera,  beri-beri,  etc.,  against  which  all  nations  are  endeavoring- 
to  protect  themselves. 

THE  CHAIRMAN.  Let  the  motion  of  Dr.  Mendizabal  be  referred  to 
the  Advisory  Committee. 

DR.  WYMAN.  I  beg  leave  to  present  to  the  Convention  a  report 
from  Dr.  A.  H.  Doty,  of  New  York,  in  compliance  with  some  of  the 
features  of  the  preliminary  programme,  and  he  has  also  transmitted 
photographs  of  the  work  that  has  been  going  on  in  Staten  Island  for 
the  elimination  of  mosquitos  by  drainage  of  swamps.  I  will  turn  this 
in  to  the  Secretary  for  such  use  as  he  may  be  able  to  make  of  the 
illustrations  or  of  the  articles  in  question.  I  would  suggest  that  the 
photographs  might  be  left  on  the  tables  for  the  members  to  examine. 

I  also  wish,  Mr.  President,  to  invite  attention  to  some  very  inter- 
esting papers  that  have  been  transmitted  by  Dr.  Samuel  G.  Dixon, 
Commissioner  of  Public  Health  of  the  State  of  Pennsylvania.  They 
have  come  to  me  since  my  arrival  in  Mexico,  and  I  have  placed  them 
on  the  table.  They  show  the  operations  of  the  Department  of  Health 
of  the  State  of  Pennsylvania  in  its  several  divisions,  with  a  number  of 
photographic  illustrations. 

Dr.  Dixon  asked  me  to  kindly  transfer  these  to  Dr.  Liceaga  as 
President  of  the  Superior  Board  of  Health,  after  they  have  been  ex- 
amined by  the  members  of  this  Convention,  and  I  trust  that  Dr. 
Liceaga,  as  President  of  the  Superior  Board  of  Health,  will  kindly 
accept  them  from  Dr.  Dixon. 

I  move  that  the  reading  of  that  report  be  dispensed  with  at  the 
present  time.  I  think  it  would  take  quite  a  long  while,  and  it  can  be 
included  in  the  proceedings. 

THE  CHAIRMAN.  I  beg  to  remind  those  present  to  be  at  3  o'clock 
sharp  today  at  the  patio  (yard)  of  the  building  of  the  Superior  Board 
of  Health  where  the  automobiles  which  will  take  us  to  the  Colonias  de 
la  Condesa,  Roma,  and  Juarez  will  be  in  waiting  for  us.  I  again 
recommend  the  delegates  to  be  punctual. 

The  meeting  adjourned. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  8l 

Night  Session. 

The  session  was  opened  at  7  p.  m.  by  Dr.  Liceaga,  the  Chairman, 
The  following  delegates  were  present:  Doctors  Oswaldo  Gongalvez 
Cruz,  Ricardo  Guiterrez  Lee,  Genaro  Payan,  Hugo  Roberts,  Juan 
Guiteras,  Ernesto  Soza,  Pedro  L.  Ferrer,  Juan  Horacio  Estevez,  Wal- 
ter Wyman,  R.  H.  von  Ezdorf,  H.  L.  E.  Johnson,  Salvador  Ortega, 
Jose  Azurdia,  Luis  Lazo  Arriaga,  Engineer  Hilario  Elguero,  Doctors 
Gregorio  Mendizabal,  Rodolfo  B.  Gonzalez,  Ernesto  Fernandez  Espiro, 
and  Dr.  Juan  J.  Ulloa,  Secretary.  The  minutes  of  the  morning  ses- 
sions were  read  and  discussed. 

DR.  ROBERTS.  Mr.  Chairman :  I  have  presented  two  propositions  so 
that  they  may  be  taken  into  consideration  at  the  next  Convention,  and 
I  notice  that  only  one  of  them  is  mentioned  in  the  minutes. 

THE  SECRETARY.  Dr.  Roberts  is  right.  Owing  to  an  involuntary 
omission,  said  proposition  is  not  mentioned  in  the  minutes,  but  it 
will  be  added  to  them. 

The  minutes  were  approved  as  corrected. 

THE  CHAIRMAN.  The  subjects  to  be  discussed  at  to-night's  session 
are  the  following:  Reading  of  such  papers  as  may  be  submitted,  the 
object  of  which  is  to  discover  the  germs  of  yellow  fever;  those  the 
purpose  of  which  is  to  determine  whether  there  are  other  mediums  of 
transmitting  yellow  fever  and  malaria,  than  the  mosquito  bite,  and 
such  other  essays  as  may  be  submitted  dealing  on  the  improvement  of 
the  method  of  warring  against  mosquitoes.  These  are  the  subjects  to 
be  discussed,  and  if  the  Convention  will  permit,  I  will  grant  the 
floor  to  Dr.  Soza,  delegate  of  Chile,  so  that  he  may  read  a  paper 
on  the  manner  of  combatting  tuberculosis  on  board  railway  cars  and 
steamers.  . 

DR.  SOZA.  Mr.  Chairman:  I  have  the  honor  to  submit  to  the  Ad- 
visory Committee  the  following  summary  which  agrees  with  the  several 
motion  made  by  the  following  delegates :  Dr.  Ricardo  Gutierrez  Lee, 
of  Colombia;  Dr.  Hugo  Roberts,  of  Cuba;  Dr.  R.  H.  von  Ezdorf,  of 
the  United  States;  Dr.  H.  L.  E.  Johnson,  of  the  United  States;  Dr. 
Jose  Azurdia,  of  Guatemala,  Dr.  Luis  Lazo  Arriaga,  of  Honduras; 
Dr.  Eduardo  Liceaga,  of  Mexico,  and  the  Chilean  Delegation. 

1.  To  avoid,  as  far  as  possible,  the  use  of  fixed  carpets  and  curtains. 

2.  To  recommend  the  use  of  cuspidors  which  should  be  profusely  distributed. 

3.  The  daily  disinfection  of  cars  or  berths,  including  furniture,  beds,  wash 
basins,  etc.    All  clothes,  including  napkins,  should  be  disinfected  before  being 
washed. 

4.  The  disinfection  of  dining  room  utensils.     To  avoid  keeping  napkins  to- 
gether, or  if  so  kept,  each  should  be  covered  with  an  envelope  of  the  same  cloth, 
and  to  avoid  the  entrance  of  flies  to  the  kitchen,  to  the  cook's  quarters,  etc.,  by 
covering  all  openings  with  wire  gauze. 

5.  The  examination  of.  the  personnel  before  employing  the  same,  and  dismissal 
from  service  should  any  of  them  be  afflicted  with  tuberculosis. 

6.  All  steamers  and  railway  trains  should  be  provided  with  a  special  and 
comfortable  department  for  the  transportation  of  consumptives,  and  upon  trans- 
porting them  projecting  decorations,  acute  angles  and  holes  that  may  favor  the 
retention  of  dust,  should  be  avoided. 

7.  The  posting  of  notices  in  conspicuous  places  which  shall  re^ad  as  follows : 

"TO  SPIT  ON  THE  FLOOR  IS  A  DIRTY  AND  IMPOLITE  HABIT,  AND  IN  MANY  INSTANCES 
CAUSES  THE  SPREAD  OF  CONTAGIOUS  DISEASES/' 

8.  Physicians  on  board  steamers  should  be  graduate  practitioners. 


82  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

THE  CHAIRMAN.  As  it  was  decided  this  morning,  this  proposition 
will  be  referred  to  the  Advisory  Committee  for  the  proper  considera- 
tion and-  decision.  Dr.  Payan  will  now  read  the  recommendations 
of  the  Committee  on  Malaria,  so  that  they  may  be  referred  to  the 
Advisory  Committee.  I  beg  Dr.  Guiteras  to  kindly  translate  them 
into  English. 

DR.  PAYAN  then  read  the  following  document : 

The  Committee  on  Malaria  of  the  Third  International  Sanitary  Convention, 
after  having  considered  the  different  motions  made  on  malaria  submitted  by 
Doctors  Azurdia,  Lazo  Arriaga,  Guiteras,  von  Ezdorf,  and  Hugo  Roberts,  and 
after  hearing  the  opinions  expressed  by  the  delegates  who  participated  in  the 
discussion  of  the  same,  has  decided  to  submit  to  the  Advisory  Committee  the 
following  resolution: 

1.  To  recommend  to  the  governments  represented  at  the  International  Sani- 
tary Convention  that  quinine  salts,  fine  wire  gauze  to  be  used  for  protection 
against  mosquitoes,  crude  petroleum,  ready-made  mosquito  nets  and  material 
used  in  their  manufacture,  be  exempt  from  customs  duties. 

2.  To   recommend   that  the   governments,  through   their   respective    sanitary 
authorities,  carry  out  the  most  active  popular  propaganda  concerning  a  knowl- 
edge of  the  etiology,  prophylaxis  and  treatment  of  malaria,  and  to  encourage 
public  lectures  on  said  subject  in  the  schools,  shops,  barracks,  etc. 

3.  To  recommend  that  there  shall  be  established  in  such  places  as  may  be 
necessary,  headquarters  for  the  distribution,  gratis,  of  quinine  among  the  poor 
on  medical  prescriptions  and  for  the  prophylaxis  of  malaria. 

4.  To  recommend  to  the  governments  to  direct  that  the  sanitary  maritime  au- 
thorities shall  state  in  bills  of  health  issued  by  them,  the  mortality  caused  by 
malaria. 

5.  To  recommend  to  the  International  Sanitary  Bureau  permanently  estab- 
lished in  Washington,  the  sending  of  regular  reports  concerning  the  existence 
of  malaria  in  the  principal  seaports. 

6.  To  likewise  recommend  to  the  governments  the  publication  of  a  handbook 
in  which  shall  be  compiled,  in  a  brief,  simple  and  practical  form  easily  under- 
stood by  the  people,  information  concerning  malaria,  and  afterwards  to  have  an 
understanding  with  the  Governments  on  the  matter  so  that  they  may  cause 
the  handbook  to  be  extensively  distributed. 

The  Chairman  again  read  the  subjects  of  the  program  open  to 
discussion,  and  asked  if  any  of  the  delegates  wished  to  make  any 
remarks. 

DR.  GUITERAS.  I  have  a  short  paper  that  I  am  going  to  read  con- 
cerning the  last  subject  of  to-day's  program,  that  is  to  say,  the  cam- 
paign against  yellow  fever  and  mosquitoes,  but  before  reading  it,  I 
wish  to  refer  to  the  second  subject  mentioned  in  said  program,  or 
that  which  has  for  its  object  the  determining  whether  there  are  other 
means  of  transmitting  yellow  fever  and  malaria  in  addition  to  the 
mosquito  bite.  With  regard  to  this  matter,  I  wish  merely  to  say 
that  the  constant  experiments  made  at  the  ''Hospital  de  Las  Animas," 
established  in  1901,  concerning  this  disease  continue  to  show  from  day 
to  day  that  there  is  no  other  medium  for  the  transmission  of  yellow 
fever.  The  experiment  to  which  I  refer  for  the  treatment  of  the 
cases  which  occurred  in  said  hospital,  taken  from  the  focus  where  the 
disease  originated,  and  since  that  year  yellow  fever  has  not  spread 
to  any  considerable  extent  among  those  who  are  not  immune.  There- 
fore, I  consider  this  an  experiment  which  shows  from  day  to  day  that 
there  is  no  medium  for  the  transmission  of  said  disease.  The  report 
I  am  going  to  read  is  based  on  a  tour  of  inspection  to  Cienfuegos.  (See 
Appendix,  page  166.) 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  83 

(On  concluding  the  reading  of  his  report,  Dr.  Guiteras  was  enthu- 
siastically applauded.) 

THE  CHAIRMAN.  Dr.  Guiteras  has  just  handed  to  the  Chair  the 
translation  into  English  of  the  paper  he  has  just  read. 

Gentlemen:  I  have  listened  with  great  pleasure  to  the  interesting 
report  made  by  Dr.  Guiteras.  In  this  transmissible  disease,  yellow 
fever,  the  most  important  point  lies  in  the  detection  of  the  first  cases. 
When  the  sanitary  authorities  know  the  focus  of  infection,  then  it 
may  be  said  that  they  have  found  the  Ariadna  thread,  which  was  what 
happened  in  the  instance  referred  to  by  Dr.  Guiteras,  and  then  it  can 
be  said  that  the  disease  is  controlled.  If  the  cases  were  not  so  numer- 
ous among  the  military  force  as  among  civilians,  what  Dr.  Guiteras  has 
just  told  us  would  be  sufficient.  In  the  case  referred  to  by  Dr. 
Guiteras,  it  was  evidently  possible  to  determine,  as  he  has  just  said, 
that  the  mosquitoes  which  attack  the  military  force  came  from  the 
midst  of  civilians,  and  in  this  instance  it  was  possible  to  extinguish 
the  disease  because  the  focus  was  found.  Whoever  has  the  good 
fortune  to  detect  the  first  cases  may  be  sure  of  success.  We  are  fol- 
lowing the  process  that  Dr.  Guiteras  has  just  set  forth  by  means  of  the 
flying  brigades  (I  don't  know  whether  they  are  called  by  another 
name  in  other  Spanish  countries,  but  among  us  we  call  by  this  name 
the  groups  of  men  who  go  from  one  place  to  another  to  discover  the 
occurrence  of  new  cases). 

I  wish  to  state  in  as  few  words  as  possible  the  process  we  tollow  in 
our  struggle  against  yellow  fever.  The  first  report  is  considered  as  the 
fundamental  basis ;  we  have  yellow  fever  spies  everywhere  who  give  us 
the  alarm  by  saying:  There  is  a  suspected  case  in  such  and  such  place. 
As  the  towns  are  not  far  from  each  other,  and  as  there  are  means  of 
communication,  such,  for  instance,  as  the  railroads  which  cross  the 
State  of  Veracruz,  I  receive  the  report  by  telegraph  and  by  the  same 
means  I  forward  the  information  to  the  chief  of  the  flying  brigade  so 
that  he  may  immediately  start  to  investigate  the  case.  Then  he  goes  to 
the  place,  provided  with  "all  the  elements  of  disinfection  and  for  isolat- 
ing the  patient.  The  isolation  is  made,  steps  are  taken  to  find  suspected 
persons,  and  afterwards  the  disinfection  is  made  not  only  of  the  houses 
occupied  by  the  patients,  but  also  of  those  surrounding  them.  When 
this  operation  has  been  completed,  the  second  follows,  namely,  the 
destruction  of  the  larvae,  so  that  they  may  be  quickly  exterminated. 
This  process  has  given  excellent  results,  and  if  I  have  taken  the  liberty 
to  call  attention  to  it,  it  is  simply  in  order  to  ratify  the  views  expressed 
by  Dr.  Guiteras. 

As  to  the  difficulties  for  disinfecting  the  dwellings,  we  have  not  en- 
countered the  great  ones  to  which  Dr.  Guiteras  has  referred,  because 
it  is  the  houses  of  the  poor  that  we  have  to  disinfect,  and  they  are  scant- 
ily furnished,  and  whatever  furniture  they  have  is  of  little  value,  and 
if  necessary  we  pay  for  it.  Therefore,  said  houses  can  be  readily  dis- 
infected by  simply  covering  the  doors  and  windows.  Should  "it  be 
impossible  to  do  so,  then  the  sheet  referred  to  by  Dr.  Guiteras  is  ap- 
plied, which  we  call  Victoria,  after  the  city  where  Dr.  Del  Rio  in- 
vented it,  and  I  will  now  tell  you  the  history  of  it  because  it  is  inter- 
esting. In  1903  we  had  yellow  fever  in  the  city  of  Victoria,  capital  of 
the  State  of  Tamaulipas,  and  there  we  found  a  very  intelligent  person 


84  THIRD    INTERNATIONAL   SANITARY    CONVENTION. 

whom  Dr.  Guiteras  knew,  namely,  Dr.  Narciso  Del  Rio.  He  was  a 
very  active  man,  and  for  the  treatment  of  and  campaign  against  yellow 
fever,  I  imposed  upon  him  the  following  conditions :  "You  must  not 
leave  until  the  town  is  disinfected." 

Dr.  Del  Rio  made'  many  attempts  at  lisinfection,  but,  inasmuch  as 
the  disease  reproduced  itself  continuously  in  the  poor  people's  huts, 
which  had  poorly  joined  walls,  or  common  reed  grass  which  leaves 
large  cracks  between  each  other,  and  grass  roofs,  through  which  the 
mosquitoes  escape  and  render  the  disinfection  inefficient,  he  almost 
despaired  of  solving  the  problem  of  disinfecting  the  huts,  or  jacales, 
as  they  are  called  in  Mexico.  As  I  insisted  that  it  was  necessary  to 
completely  eliminate  yellow  fever  from  the  City  of  Victoria,  Dr.  Del 
Rio  first  devised  the  idea  of  wrapping  up  the  huts  in  a  canvas  sheet. 
He  was  led  to  devise  this  means  by  the  knowledge  he  had  of  the  fact 
that  the  mosquitoes  upon  smelling  sulphurous  acid  fly  out  of  the  room 
to  be  disinfected,  or  from  the  hut,  as  the  case  may  be,  through  the 
cracks  through  which  light  penetrates.  You  know  the  smallest  cracks 
are  sufficient  for  the  escape  of  mosquitoes,  as  was  shown  by  the  ex- 
perimental study  made  by  the  same  doctor,  which  consisted  in  closing 
a  room  air  tight,  leaving  the  key  hole  uncovered,  and  covering  the  lock 
with  a  funnel  with  the  vertex  closed ;  introduce  ten  mosquitoes  in  the 
room  where  formerly  there  were  none,  burn  the  sulphur  and  then  it 
was  observed  that  of  the  ten  mosquitoes  seven  had  died  and  three  of 
them  had  escaped  through  the  lock  of  the  door  and  were  held  prisoners 
in  the  glass  funnel  that  had  been  placed  there  in  order  to  prevent  their 
escape.  Therefore,  the  problem  consisted  in  covering  all  the  cracks 
and  openings  through  which  the  light  penetrates. 

The  process  invented  by  Dr.  Del  Rio  to  prevent  the  escape  of  the 
mosquitoes  and  which  I  described  in  Havana  in  January,  1904,  during 
the  sessions  held  by  the  American  Public  Health  Association,  is  the 
following:  Take  a  strip  of  canvas  of  regular  width,  nail  it  to  the 
ground  against  one  of  the  side  walls  of  the  hut;  spread  the  cloth 
tightly  against  the  wall  until  it  reaches  a  point  underneath  the  eaves 
of  the  roof;  fix  it  there  with  a  strip  of  wood  attached  to  the  wall  by 
means  of  a  support  resting  on  the  floor,  continue  spreading  the  canvas 
strip  around  the  eaves  of  the  house,  and  so  on  with  the  inclined  plane 
constituting  the  roof;  then  draw  it  down  through  the  other  inclined 
plane  of  the  opposite  side;  turn  it  under  the  eaves  of  that  side  of  the 
hut  until  it  reaches  the  vertical  wall  where  it  is  fixed  by  means  of  a 
wooden  cross  beam  or  strip  similar  to  that  of  the  other  side ;  then  the 
strip  of  canvas  is  caused  to  follow  the  wall  into  the  interior  where  it 
is  again  nailed  down.  On  this  strip  of  canvas  the  following  is  placed 
overlapping  each  other,  and  on  this  layer  another  is  placed,  and  so 
until  the  whole  length  of  the  hut  is  covered.  Then  the  front  and  rear 
part  of  the  hut  remains  to  be  covered.  This  is  accomplished  by  sew- 
ing together  other  canvas  strips,  the  extent  and  shape  of  which  must  be 
the  same  as  those  of  the  front  of  the  hut  to  be  covered,  and  the  piece 
is  united  by  means  of  a  seam  to  the  first  of  the  strips  already  men- 
tioned. A  similar  operation  is  made  with  regard  to  the  rear  of  the 
hut.  Before  closing  the  last  part,  the  combustion  of  the  sulphur  is 
started,  and  the  entrance  door  is  closed.  Then  the  hut  is  closed  air 
tight  within  the  canvas  cover,  as  shown  by  the  drawings  which  I  have 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  85 

the  pleasure  to  submit  to  this  assembly.  I  again  repeat  that  I  de- 
scribed this  model  in  Havana,  in  January,  1904.  To  be  brief,  I  will  say 
that  the  experience  we  have  acquired  enables  us  to  advise,  as  Dr. 
Guiteras  has  just  said  that  it  hapened  in  his  case,  that  it  is  necessary 
immediately  to  look  for  the  focus  until  it  is  found,  and  to  apply  to 
every  house  or  hut  the  aforesaid  process  by  using  the  said  cover,  and 
then  there  is  no  danger  of  mosquitoes  escaping  through  the  openings. 
(Applause.) 

DR.  GoNgALVEZ  CRUZ.  The  struggle  against  yellow  fever  at  Rio  de 
Janeiro,  by  means  of  the  fumigation  of  the  houses  covered  with  canvas, 
in  order  to  prevent  the  escape  of  the  mosquitoes,  was  tried'  at  different 
times.  This  process  was  employed  in  all  houses  of  whatever  con- 
struction and  was  adopted  from  the  beginning  of  the  campaign  against 
yellow  fever. 

THE  CHAIRMAN.   Does  any  other  person  wish  to  make  any  remarks  ? 

In  accordance  with  the  rules  adopted  from  the  beginning  of  the 
sessions,  we  should  proceed  to  discuss  the  following  subjects,  but  those 
to  be  discussed  in  the  morning  session  are  of  such  a  character  that  it 
would  not  be  possible  to  discuss  them  in  this  one,  since  they  are  pend- 
ing decision  in  the  Advisory  Committee,  and  with  regard  to  the  sub- 
mission by  each  delegate  of  a  paper  concerning  the  organization  in  his 
country  of  a  committee  composed  of  three  physicians  or  sanitary 
officials  for  the  purpose  of  forming  part  of  the  International  Sanitary 
Information  Committee  of  the  American  Republics,  although  it  would 
be  the  only  subject  that  could  be  discussed,  I  would  say  that,  so 
far  as  I  am  concerned,  although  the  organization  is  already  made, 
I  have  no  official  advice  in  the  matter,  and  I  think  the  same  is  true  of 
the  other  delegates.  At  all  events,  I  would  request  that  the  session  be 
adjourned  so  that  the  Advisory  Committee  may  have  sufficient  time  to 
work,  especially  in  view  of  the  fact  that  the  session  will  only  last  20 
minutes  more.  The  session  is,  therefore,  adjourned. 


86  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 


SIXTH  DAY,  SATURDAY,  DECEMBER  7. 

Morning  Session. 

The  session  was  opened  at  9  a.  m.  under  the  presidency  of  Dr. 
Liceaga,  the  following  delegates  being  present :  Dr.  Oswaldo  Gon- 
galvez  Cruz,  Dr.  Ricardo  Gutierrez  Lee,  Dr.  Genaro  Payan,  Dr.  Hugo 
Roberts,  Dr.  Juan  Guiteras,  Dr.  Ernesto  Soza,  Dr.  Pedro  L.  Ferrer, 
Dr.  Juan  Horacio  Estevez,  Dr.  Salvador  Ortega,  Dr.  Jose  Azurdia, 
Dr.  Luis  Lazo-Arriaga,  Lie.  Jose  Algara,  Engineer  Hilario  Elguero, 
Dr.  Gregorio  Mendizabal,  Dr.  Rodolfo  B.  Gonzalez,  Dr.  Ernesto  Fer- 
nandez Espiro,  Dr.  Walter  Wyman,  Dr.  R.  H.  von  Ezdorf,  Dr.  J.  Gate- 
wood,  Dr.  Rhett  Goode,  Dr.  H.  L.  E.  Johnson,  and  Dr.  Juan  J.  Ulloa. 

The  minutes  of  the  preceding  session  were  read  and  approved  without 
discussion. 

THE  CHAIRMAN.  In  the  morning  session  of  today  the  following 
matters  will  be  taken  into  consideration:  Discussion  of  pending  mat- 
ters; adoption  of  the  resolutions  taken  in  the  preceding  sessions;  pre- 
sentation by  each  delegate  of  a  report  regarding  the  organization  in 
his  country  of  a  commission  composed  of  three  physicians  or  health 
officers  for  the  purpose  of  forming  part  of  the  International  Sanitary 
Informing  Commission  of  the  American  Republics. 

THE  SECRETARY.  I  will  take  the  liberty  to  read  the  first  resolution 
adopted  by  the  Executive  Committee : 

The  Executive  Committee  has  the  honor  to  submit  to  your  consideration  the 
following  report  on  the  different  subjects  referred  to  it — 

ist.  To  request  the  delegates  from  the  Governments  of  Brazil,  Colombia,  and 
Uruguay,  subject  to  the  full  powers  with  which  they  are  invested,  to  adhere  to 
the  Sanitary  Convention  of  Washington  of  1905. 

THE  CHAIRMAN.  I  beg  to  submit  this  resolution  to  the  approval  of 
the  delegates  and  I  would  allow  myself  to  request  the  Delegation  from 
Chile  to  declare  also  their  adherence,  as  Dr.  Ferrer  gave  us  yesterday 
the  most  pleasant  news  that  the  Government  of  his  country  has  already 
under  its  consideration  the  ratification  of  said  convention  and  has  mani- 
fested its  adherence.  Therefore,  I  do  not  believe  it  necessary  for  said 
delegation  to  make  its  adherence  by  signature. 

DR.  FERRER.  I  thank  the  President  for  his  kind  words,  and  beg  to 
state  that  the  Chilean  Delegation  will  have  the  honor  to  affix  its  signa- 
ture to  said  resolution. 

THE  CHAIRMAN.  But  as  it  was  already  adopted  by  the  Chilean  Dele- 
gation and  signed  by  its  representative,  I  said  that  we  would  take  into 
consideration  the  words  expressed  by  the  Delegation  of  said  Republic, 
stating  at  the  same  time  it  was  not  necessary  for  that  Delegation  to 
affix  its  signature  to  the  resolution  in  question  because  the  adherence 
had  already  been  made. 

The  resolution  was  adopted. 

DR.  LAZO-ARRIAGA.  In  the  name  of  Honduras,  I  will  have  great 
pleasure  in  signing. 


DR.  JUAN  J.  ULLOA,  OF  COSTA  RICA, 

Permanent    Secretary;    President-elect    of    the    Fourth    International    Sanitary 
Convention  to  be  held  in  San  Jose  de  Costa  Rica  in  December,  1909. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  8/ 

DR.  GUTIERREZ.  We  accept  and  are  ready  to  sign  the  adherence  ad 
referendum. 

DR.  FERNANDEZ  ESPIRO.  I  also  accept  and  with  the  greatest  pleasure 
I  manifest  my  adherence. 

Dr.  Gongalvez  Cruz,  Delegate  from  Brazil,  also  adhered  in  the  name 
of  his  country. 

THE  CHAIRMAN.  I  am  now  going  to  have  a  copy  made  of  this  reso- 
lution in  Spanish,  English,  and  Portuguese,  so  that  it  may  be  signed  by 
all.  It  is  indispensable  that  there  be  a  center  and  this  is  the  Department 
of  State  of  the  United  States.  Therefore,  one  of  the  acts — because  this 
is  an  act — will  have  to  be  sent  to  the  Department  of  State  of  the 
United  States  and  another  will  be  formally  filed  with  the  Department, 
of  Foreign  Relations  of  this  Republic. 

As  the  Secretary  is  going  to  withdraw  in  order  to  prepare  the  reso- 
lutions that  were  adopted  last  night  by  the  Advisory  Committee,  I 
request  Dr.  Guiteras  that  he  be  kind  enough  to  act  as  Secretary. 

Dr.  Guiteras  took  the  Secretary's  chair. 

THE  CHAIRMAN.  As  we  will  have  to  wait  until' the  resolutions  of  the 
Committee  are  ready,  I  move  that  another  matter  described  in  the  pro- 
gramme be  taken  up,  and  that  the  Delegate  from  Brazil  be  kind  enough 
to  make  the  presentation  referred  to  in  Section  4. 

DR.  GONQALVEZ  CRUZ  (Reading)  : 

ORGANIZATION  OF  THE  BRAZILIAN  COMMITTEE  TO  FORM  PART  OF  THE  INTERNATIONAL 
SANITARY   INFORMING  COMMISSION   OF  THE  AMERICAN  REPUBLICS. 

The'  Brazilian  Commission  will  be  constituted  by  the  Chief  of  the  Demographic 
Service  of  the  General  Bureau  of  Public  Health,  and  of  two  assistant  physicians 
from  the  same  division. 

The  organization  of  that  service  is  already  provided  for  in  Section  18  of  the 
Regulations  of  the  Sanitary  Services  in  charge  of  the  Union. 

The  Division  of  Demography  publishes  its  reports  in  weekly,  monthly,  and 
yearly  bulletins.  The  monthly  and  the  annual  bulletins  will  constitute  the  source 
of  information  that  Brazil  will  furnish  to  the  International  Commission. 

DR.  FERNANDEZ  ESPIRO.  I  believe  that  no  other  delegate  is  in  the 
same  position  as  the  Delegate  of  Brazil  to  present  at  this  moment  a 
report  regarding  the  constitution  of  a  commission  of  three  physicians 
provided  for  in  the  programme.  Therefore,  I  would  make  the  follow- 
ing motion :  That  the  Delegates  of  the  different  American  Republics, 
upon  arriving  at  their  respective  countries,  manifest  to  their  Govern- 
ments the  convenience  and  urgent  necessity  of  constituting  a  commis- 
sion of  three  persons,  and  that  as  soon  as  the  Governments  shall  have 
appointed  said  committees,  the  International  Bureau  at  Washington 
be  notified.  I  believe  that  this  is  the  most  practical  solution,  as  I  un- 
derstand that  none  of  us  is  empowered  to  propose  which  persons 
should  constitute  said  committee. 

THE  CHAIRMAN.  I  agree  with  the  motion  of  Dr.  Fernandez,  but  as  I 
am  authorized,  as  my  delegation  is  authorized,  I  am  going  to  read  the 
report  which  it  submits.  I  repeat  that  I  am  entirely  in  accord  with  the 
motion  that  such  delegates  as  are  not  expressly  empowered  by  their 
Governments  may  fulfill  this  provision  of  the  programme  in  the  manner 
suggested  by  Dr.  Fernandez,  and  then  his  motion  is  placed  before 
the  Convention,  reserving  myself  the  right  to  read  the  report  that  I 
have. 


88  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

DR.  LAZO  ARRIAGA.  I  agree  with  the  motion  of  Dr.  Fernandez,  be- 
cause, although  I  am  authorized  to  designate  the  persons  that  would 
constitute  the  Committee  in  question,  in  accordance  with  the  laws  of 
my  country,  it  is  the  Government  who  makes  these  appointments. 

THE  CHAIRMAN.  Gentlemen,  Section  4  of  the  provisional  programme 
of  this  Convention  says : 

Each  Delegate  shall  present  a  report  regarding  the  organization  in  his  country 
of  a  Committee  composed  of  three  physicians  or  health  officers  to  form  part  of 
the  International  Sanitary  Informing  Commission  of  the  American  Republics, 
as  is  provided  by  paragraph  3  (b)  of  the  resolutions  adopted  in  Rio  de  Janeiro. 

As  the  intention  of  this  provision  is  to  create  a  center  of  information 
for  all  the  American  Republics,  I  believe  that  its  purpose  is  carried  out 
as  regards  Mexico,  by  appointing  the  Superior  Board  of  Health  as  the 
Committee  to  form  part  of  the  Informing  Commission,  as  it  is  a  federal 
sanitary  office  which  compiles  directly  the  statistics  relating  to  public 
health  of  the  ports,  border  cities,  and  other  important  centers  of  the 
country,  and  is  thus  enabled  to  fulfill  easily  the  purposes  sought  by  the 
Rio  de  Janeiro  Conference.  But  in  order  to  conform  with  the  letter  of 
the  provision  in  question  the  Superior  Board  of  Health  appoints  as 
members  of  the  Committee  Dr.  Eduardo  Liceaga,  Dr.  Nicolas  Ramirez 
de  Arallalo,  and  Dr.  Jesus  E.  Monjaras. 

Its  organization  shall  be  the  same  as  that  of  the  Superior  Council  of 
Health,  which  is  the  advisory  board  of  the  Government  of  the  Republic. 

DR.  FERNANDEZ  ESPIRO.  The  Third  Pan-American  Conference  of 
Rio  de  Janeiro  provided  that  Montevideo  should  be  one  of  the  centers 
of  information  to  be  in  communication  with  the  International  Sanitary 
Bureau  of  Washington,  but  I  do  not  know  that  that  Conference  speci- 
fied which  should  be  the  Republics  that  should  send  their  communica- 
tions to  the  International  Bureau  at  Washington  so  that  this  center 
might  in  turn  send  its  reports  to  Montevideo.  Therefore,  I  would  like 
that  this  point  be  decided  by  the  Convention  in  order  to  avoid  any 
future  controversies  which  might  hinder  the  routine  of  said  reports. 

THE  CHAIRMAN.  I  believe  it  would  be  wise  to  take  into  consideration 
the  motion  of  the  Delegate  from  Uruguay,  for  it  is  not  sufficient  to  es- 
tablish centers  of  information.  It  is  understood  that  the  intention  of  the 
Rio  de  Janeiro  Conference  was  to  provide  a  speedy  and  efficient  method 
of  furnishing  the  data  required,  and  to  that  end  it  established  three 
centers  in  the  world,  one  in  Paris,  another  in  Washington,  and  another 
in  Montevideo.  What  is  proper  and  logical  is  to  adopt  the  following  di- 
vision :  From  Ecuador  towards  the  north  to  Washington ;  from  Ecuador 
towards  the  south  to  Montevidio ;  these  two  centers  might  communicate 
with  the  center  in  Paris.  This  division  seems  to  me  the  most  natural 
one,  and  it  is  the  resolution  that  I  submit  to  the  Convention,  because  this 
Convention,  originated  by  the  Rio  de  Janeiro  Conference,  should  inter- 
pret such  doubtful  points  as  may  exist  in  the  resolutions  adopted  by  the 
latter. 

DR.  ESTEVES.  As  Ecuador  remains  in  the  dividing  line  I  would  like 
to  know  if  it  belongs  to  the  northern  or  to  the  southern  section. 

THE  CHAIRMAN.  According  to  my  proposition,  it  belongs  to  the 
northern  section. 

DR.  GUITERAS.  It  seems  to  me  that  we  ought  not  to  limit  ourselves 
to  the  Equatorial  line,  but  that  instead  the  countries  near  to  Washington 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  89 

should  establish  communication  therewith,  and  those  farther  south  with 
Montevideo. 

DR.  ESTEVES.  It  seems  to  me  that  Ecuador  is  farther  north  and  it  is 
nearer  Washington  than  Montevideo. 

DR.  GUTIERREZ.  I  believe  that  it  is  very  easy  for  us,  now  that  we  are 
here  assembled  with  brotherly  purposes,  to  determine  which  should  be 
the  center  to  which  we  should  address  our  reports.  I  believe  that  Brazil, 
Argentina,  Uruguay,  Paraguay,  and  Chile  have  their  center  in  Monte- 
video; Ecuador,  Venezuela,  Colombia,  and  the  Central  American 
Republics,  in  Washington ;  Peru,  being  more  accessible  to  the  Isthmus 
of  Panama,  should  also  address  to  Washington;  furthermore,  the 
official  and  commercial  communications  of  this  latter  Republic  are  sent 
via  Panama.  Regarding  the  Colonies  in  the  Continent,  belonging  to 
Holland,  France,  etc.,  such  as  English  Guiana  and  others  which  are  not 
included  in  our  International  Convention,  I  will  say  that  we  should  take 
them  into  consideration,  because  in  Cayenne,  as  well  as  in  Georgetown, 
cases  of  yellow  fever  have  been  recorded ;  this  is  a  question  upon  which 
I  would  call  the  attention  of  the  Convention  in  order  that  we  may  have 
connection  with  said  Colonies  as  a  whole,  thus  establishing  sanitary 
relations  with  them. 

THE  CHAIRMAN.  Precisely.  The  remarks  just  made  by  the  Delegate 
from  Colombia  show  the  advisability  of  establishing  relations  between 
the  information  centers  of  Washington  and  Montevideo  and  the  central 
bureau  of  Paris ;  but  until  an  agreement  is  reached  we  will  not  be  able 
to  determine  anything  in  regard  to  said  colonies,  for,  although  they  are 
in  America,  they,  are  European  dependencies,  and  it  is  not  within  our 
power  to  make  any  provisions  in  regard  to  them.  The  most  proper 
and  logical  course  is  that  indicated  by  Dr.  Gutierrez.  These  colonies 
should  send  their  reports  to  America  because  their  sanitary  interests 
are  more  closely  related  with  the  Continent  than  with  Europe.  I  do  not 
believe  that  we  ought  to  decide  this  question  but  only  outline  it,  be- 
cause this  Convention  cannot  adopt  a  resolution  as  the  previous  one,  for 
as  long  as  the  Chiefs  of  the  three  centers  do  not  reach  an  agreement, 
whatever  decision  we  might  take  would  only  be  a  theoretical  one,  and 
as  all  our  resolutions  should  be  highly  practical  and  effective,  I  move 
that  the  Convention  approve  this  matter.  (Approved.) 

DR.  GUITERAS.  I  take  the  liberty  to  remind  the  Convention  that  in 
one  of  the  previous  sessions  I  submitted  a  proposition  to  the  effect  that 
an  agreement  should  be  reached  among  the  three  centers  of  information 
in  regard  to  said  colonies.  This  resolution  is  now  before  the  Executive 
Committee. 

THE  CHAIRMAN.  According  to  what  Dr.  Guiteras  has  just  now  said, 
we  will  wait  for  the  decision  that  the  Advisory  Committee  will  now  ren- 
der in  which  will  be  included  both  Dr.  Guiteras'  motion  and  mine. 

The  session  was  suspended  to  wait  for  the  report  of  the  Committee. 


The  session  was  reopened,  and  the  Secretary  read  the  decision  of  the 
Advisory  Committee,  a  translation  of  which  into  English  was  made, 
and  which  is  as  follows: 

Delegates  to  the  Third  International  Sanitary  Convention: 

"The  Advisory  Committee  has  the  honor  to  submit  to  your  consideration  the 
following  report  on  the  different  subjects  referred  to  it: 


9O  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

1.  The  representatives  of  the  Governments  of  Brazil,  Colombia  and  of  Uru- 
guay are  requested  to  adhere  to  the  Sanitary  Convention  which  was  signed  in 
Washington  in  1905. 

2.  To  the  American  governments   represented  in  this  Convention  is  recom- 
mended the  codifying  of  all  the  sanitary  laws  and  regulations  of  the  respective 
countries,  and  as  soon  as  this  is  accomplished  to  forward  copies  of  them  to  the 
International  Sanitary  Bureau  at  Washington. 

3.  The   Convention   is   recommended  to  authorize  the  International   Sanitary 
Bureau  of  Washington  to  establish  by  means  considered  by  them  to  be  most 
convenient  corresponding  relations  with  the  International   Sanitary   Bureau  of 
Paris  in  accordance  with  the  declaration  made  by  the  third  Pan-American  Con- 
gress held  in  Rio  de  Janeiro  August,  1906. 

4.  That  the  Secretary  be  authorized  to  include  in  the  publication  of  the  pro- 
ceedings of  the  Third  International  Sanitary  Convention  a  summary  of  all  the 
resolutions  adopted  by  the  first  and  second  International  Sanitary  Conventions 
held  in  Washington. 

5.  That  recommendations  be  made  to  the  American  Governments  of  the  con- 
venience of  agreeing  upon  compulsory  vaccination  against  smallpox. 

6.  That  recommendations  -be  made  to  the  Governments  represented    in    this 
Convention  of  the  convenience  of  declaring  free  from  State  taxes  the  sale  of 
quinine,  fine  wire  mosquito  netting  to  be  used  as  a  protection  against  mosquitoes, 
crude  petroleum,  mosquito  bars  and  material  used  for  that  purpose. 

7.  That  recommendations  be  made  through  the  medium  of  the  respective  sani- 
tary authorities  that  the  Governments  enter  into  a  most  active  propaganda  on 
the' etiology,  prophylaxis  and  treatment  of  malaria  and  resolve  upon  the  estab- 
lishment of  public  conferences  on  these  subjects  in  schools,  shops,  barracks,  etc. 

8.  That  recommendations  be  made  for  the  establishment  of  centers  at  neces- 
sary points  for  the  free  distribution  of  quinine  to  the  poor  in  necessary  quanti- 
ties for  the  prophylaxy  of  malaria. 

9.  That  recommendations  be  made  to  the  Governments  that  they  order  the 
maritime  sanitary  authorities  to  include  in  the  public  health  reports  which  they 
issue  the  mortality  occasioned  by  malaria. 

10.  That  recommendations  be  made  to  the  International  Sanitary  Bureau  at 
Washington  to  furnish  regular  information  in  regard  to  the  existence  of  malaria 
in  the  principal  sea  ports. 

11.  That  recommendations  be  made  to  all  Governments  alike  for  the  publica- 
tion of  a  pamphlet  in  which  be  compiled  in  a  brief,  simple  and  practical  form, 
easily  understood  by  the  public,   facts  concerning  malarial   fever,   for   liberal 
distribution. 

12.  That  recommendations  be  made  to  the  governments  that  they  prohibit  the 
immigration  of  persons  suffering  from  trachoma  and  beri-beri. 

13.  That  recommendations  be  made  to  the  various  American  nations  for  the 
legal  and  adequate  steps  in  favor  of  the  nationalization  and  centralization  of 
sanitary  authorities. 

14.  That  to  the  American  governments  be  recommended  the  following  sug- 

?jstions  for  the  prevention  of  tuberculosis  in  railway  cars  and  steamships:  (a) 
o  avoid,  as  far  as  possible,  the  use  of  carpets  and  fixed  curtains,  (b)  To 
recommend  the  use  of  spittoons  well  distributed,  (c)  Periodical  disinfection  of 
cars  and  staterooms,  including  furniture,  beds,  washbowls,  etc.  These  disinfec- 
tions should  especially  be  made  in  the  third  class.  All  clothing,  including  nap- 
kins, should  be  disinfected  before  being  washed,  (d)  Disinfection  of  dining- 
room  service  and  the  use  of  paper  envelopes  by  the  passengers  for  napkins ;  also 
that  the  food  be  covered  with  wire  screens  at  ports  and  that  the  windows  of 
railway  cars,  staterooms  and  habitations  on  vessels  be  screened  with  fine  wire 
nets  to  avoid  the  introduction  of  flies,  (e)  The  examination  of  employes  of 
vessels  and  passenger  trains  in  order  that  tuberculosis  subjects  are  not  employed, 
(f)  All  vessels  should  have  a  special  and  comfortable  department  for  the  ac- 
commodation of  tuberculosis  patients,  its  construction  not  to  admit  of  the  re- 
tention of  dust  in  any  part,  (g)  The  pasting  of  notices  in  public  places  con- 
demning the  habit  of  spitting  on  floors,  (h)  Recommending  that  the  physicians 
at  the  border  not  only  be  graduates  in  their  profession,  but,  if  possible,  to  have  a 
special  knowledge  of  the  prophylaxis  of  tuberculosis. 

15.  That  recommendation  be  made  to  the  effect  that  the  European  Nations 
adopt  the  Convention  of  Washington  of  1005,  in  their  American  colonies,  specially 
in  what  concerns  yellow  fever. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  QI 

16.  To  recommend  the  American  Nations  that  their  bills  of  health  contain  the 
same  kind  of  information. 

THE  CHAIRMAN.  The  recommendation  respecting  the  etiology  of 
yellow  fever  has  been  stricken  out.  The  resolutions  just  read  are  now 
before  the  Convention. 

DR.  ROBERTS.  I  have  presented  a  motion  regarding  the  regulations 
to  which  ships  should  be  subjected  in  order  to  protect  the  lives  of 
passengers.  I  would  like  to  know  if  it  has  been  rejected. 

THE  SECRETARY.  The  Committee  will  bear  in  mind  the  remarks  of 
Dr.  Roberts. 

DR.  WYMAN.  I  have  two  resolutions  that  I  think  are  important, 
and  I  suppose  they  may  yet  be  considered  by  the  Advisory  Council 
and  be  reported  on  this  afternoon,  or  they  could  be  adopted  by  the 
Convention  right  now.  Are  we  to  have  another  report  from  the  Ad- 
visory Council?  These  ate  the  resolutions: 

Whereas:  The  Third  International  Conference  of  American  States,  held  at 
Rio  de  Janeiro  in  August,  1906,  by  resolution  declared  that  the  delegates  to  this 
International  Sanitary  Convention  should  resolve  upon  practical  means  for  the 
adoption  of  measures  intended  to  obtain  the  sanitation  of  the  cities  and, 
specially,  of  the  ports, 

Resolved,  that  this  subject  be  one  for  consideration  also  by  the  members  of 
the  next  International  Sanitary  Convention  to  be  held  in  Costa  Rica,  and  that 
the  International  Sanitary  Bureau  in  Washington  be  authorized  to  make  inves- 
tigations and  to  take  such  other  action  as  may  be  necessary  to  present  this 
matter  in  satisfactory  form  at  the  said  Convention  in  Costa  Rica. 

Resolved,  that  the  Sanitary  Conference  recommend  the  establishment  of  Sepa- 
rate Hospitals  or  Special  Wards  for  the  treatment  of  tuberculosis  patients. 

Resolved,  that  a  location  be  furnished  by  the  Bureau  of  American  Republics 
for  the  use  of  the  International  Sanitary  Bureau. 

That  a  clerk  is  authorized  to  be  employed  and  paid  by  the  International  Bureau. 

That  expenditures  be  authorized  and  certified  to  by  the  same  Bureau. 

That  the  Bureau  of  the  American  Republics  be  charged  with  the  collection  of 
the  fund  provided  for  by  Section  7  of  the  resolutions  concerning  International 
Sanitary  Policy  adopted  by  Second  International  Conference  of  the  American 
Republics  held  in  Mexico  in  1901-1902. 

That  the  Bureau  of  the  American  Republics  is  also  charged  with  the  custody 
of  the  fund  and  keeping  of  the  accounts, 

I  will  say  in  submitting  these  post  resolutions  that  I  have  prepared 
them,  in  conjunction  with  Mr.  Yanes  who  represents  the  Bureau  of 
American  Republics  here  and  that  they  meet  with  his  approval. 

Dr.  Roberts  was  given  the  floor. 

DR.  ROBERTS.  Taking  into  consideration  the  great  advantages  that 
result  from  enforcing  sanitary  measures  as  near  as  possible  to  an  in- 
fected locality,  not  only  to  prevent  the  introduction  of  cholera,  bubonic 
plague,  and  yellow  fever  into  another  locality,  but  also  to  protect  the 
lives  of  passengers  in  ships  sailing  or  leaving  the  said  infected  locality, 
I  move : 

"That  a  resolution  be  passed  in  the  next  Convention  prescribing 
measures  to  which  should  be  subjected  passengers,  cargo,  and  ships 
leaving  an  infected  port  in  order  to  give  greater  protection  to  the  lives 
of  passengers,  preventing  the  occurrence  of  cases  on  board."     (Ap-, 
proved.) 

THE  PRESIDENT.  I  move  that  the  motions  of  Dr.  Wyman  and  Dr. 
Roberts  be  placed  before  the  Convention,  but  as  Dr.  Fernandez  Espiro 
has  asked  to  be  heard,  I  would  request  the  Delegate  from  the  United 


92  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

States  to  present  his  resolutions  afterwards  so  that  they  may  be  voted 
upon  immediately,  as  I  have  suggested. 

DR.  FERNANDEZ  ESPIRO.  I  agree  with  the  propositions  presented  by 
the  United  States  Delegation,  especially  the  second  one,  as  it  refers  to 
a  question  of  great  importance  which  will  be  adopted  by  the  Fourth 
International  Sanitary  Convention  of  American  Republics.  This  reso- 
lution of  Dr.  Wyman  refers  to  the  memoranda  that  should  be  presented 
by  the  different  delegations  in  regard  to  sanitation  works.  I  repeat 
that  I  consider  this  matter  as  one  of  high  importance,  and  I  believe  that 
it  should  be  specified  with  greater  details  so  that  the  next  Convention 
may  become  acquainted  with  all  that  has  been  done  between  the  two 
meetings,  and  I  think  that  what  the  Chair  has  done  with  respect  to  the 
proposition  of  the  Chilean  Delegation  should  be  done  in  regard  to  that 
of  Dr.  Wyman,  that  is  to  say,  it  should  be  placed  before  the  Convention 
immediately. 

The  other  point  is  this :  The  Delegations  of  Brazil  and  Uruguay  had 
presented  a  motion  providing  for  the  revision  of  the  Convention  of 
Washington,  at  the  Fourth  Convention,  on  the  understanding  that  this 
Convention  of  Washington  had  a  fixed  limit ;  but  since  there  is  no  such 
limit,  the  proposition  presented  by  the  Brazilian  and  Uruguayan  Del- 
egations is  not  necessary.  In  the  name  of  Dr.  Cruz  and  my  own,  I 
move  that  said  motion  be  withdrawn  in  order  that  it  shall  not  appear  in 
the  report  of  the  Committee. 

THE  CHAIRMAN.  I  wish  to  explain  to  Dr.  Fernandez  Espiro  the 
reason  why  we  have  adopted  the  proposition  that  persons  suffering 
from  trachoma  and  beri-beri  be  rejected.  I  consider  it  a  very  impor- 
tant question  for  us  and  for  all  the  countries. 

The  basis  consists  in  the  fact  that  both  being  acute  diseases  and  that 
in  yellow  fever,  it  is  possible  to  make  the  isolation,  and  all  nations  have 
undertaken  the  task  of  gathering  together  these  patients  and  isolating 
them,  assisting  them  until  they  recover;  but  such  process  can  not 
be  imposed  in  the  case  of  prolonged  diseases  and  when  the  cases  are 
very  numerous. 

I  am  going  to  give  an  instance,  which  I  hope  will  convince  the  dele- 
gates. It  is  only  four  months  ago  that  it  was  decided  in  Mexico  not 
to  admit  to  the  country  persons  afflicted  with  trachoma  and  beri-beri. 
Now,  during  that  period  of  time,  about  500  persons  afflicted  with  tra- 
choma have  arrived  in  the  country.  What  place  or  lazarettos  sufficient 
to  accommodate  persons  having  trachoma,  who  at  that  rate  would 
enter  the  Republic  in  a  year,  could  we  have?  For  this  reason,  we 
follow  the  rule  that  in  case  of  acute  diseases  each  nation  must  gather 
the  patients  and  place  them  in  the  proper  institutions  in  order  not 
to  compel  them  to  return  on  the  same  vessel,  but  in  the  case  of  trans- 
missible chronic  diseases  it  is  not  possible  to  do  this.  Dr.  Fernandez 
has  made  an  explanation  concerning  his  vote,  but  I  wish  the  Convention 
to  know  why  the  Advisory  Committee  has  adopted  this  resolution. 

(The  propositions  formerly  submitted  by  Doctors  Wyman  and  Rob- 
erts were  voted  upon  and  unanimously  adopted,  and  added  to  the  reso- 
lutions approved  and  submitted  by  the  Advisory  Committee.) 

DR.  ORTEGA.  As  Doctors  Liceaga  and  Ulloa  will  call  on  the  Presi- 
dent of  the  Republic,  I  take  the  Chair  at  the  request  of  the  former,  and 
Dr.  Guiteras  will  kindly  act  as  Secretary. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  93 

(Dr.  Ortega  having  taken  the  Chair,  the  floor  was  granted  to  Dr. 
Azurdia. ) 

DR.  AZURDIA.  As  to  the  point  concerning  compulsory  vaccination 
referred  to  in  a  rule  of  the  Convention,  I  would  like  that  the  following 
exception  be  made:  The  laws  of  Guatemala  provide  that  vaccination 
shall  be  compulsory,  and  said  law  implies  generally  to  all  American 
countries.  Therefore,  I  would  like  to  have  it  stated  that  this  resolu- 
tion applies  only  to  those  countries  where  vaccination  is  not  compul- 
sory. 

DR.  MENDIZABAL.  I  should  like  to  add  the  following  to  this  resolu- 
tion: That  not  only  vaccination,  but  re-vaccination,  which  is  already 
enforced  in  all  countries  of  the  world,  should  also  be  recommended. 

DR.  GUITERAS.  I  wish  to  express  my  opinion  concerning  the  first 
point.  It  seems  to  me  that  a  general  recommendation  may  be  unneces- 
sary, in  those  countries  where  vaccination  is  already  compulsory.  As 
to  the  other  recommendation,  I  have  nothing  to  say. 

THE  CHAIRMAN.  Do  the  delegates  agree  to  the  amendments  pro- 
posed by  Doctors  Azurdia  and  Mendizabal? 

DR.  GUTIERREZ.  I  believe  this  is  a  question  of  phraseology.  If  the 
countries  have  already  established  vaccination  in  their  laws,  it  is  not 
necessary  to  allude  to  it  in  a  new  resolution. 

DR.  AZURDIA.  I  second  the  proposition  of  Dr.  Mendizabal  in  regard 
to  vaccination. 

DR.  ROBERTS.  I  believe  that  by  using  the  words  "vaccinal  immunity" 
the  question  would  be  settled,  and  I  make  this  suggestion  for  the  sake 
of  brevity. 

DR.  GUTIERREZ.  I  thought  it  was  sufficient  to  make  that  one  recom- 
mendation, because  the  word  vaccination  is  the  common  term,  and  re- 
vaccination  is  not  a  new  term.  But  if  we  use  the  words  vaccinal 
immunity  they  will  be  understood,  but  they  will  not  have  the  exact 
meaning  given  them  by  the  Government  and  the  people,  because  the 
phrase  is  technical.  Therefore,  I  think  the  word  vaccination  is  suffi- 
cient, because,  although  re-vaccination  is  necessary  after  eight  or  ten 
years,  I  understand  that  the  same  is  compulsory,  because  in  case  of  an 
outbreak  of  smallpox  the  people  themselves  would  request  re-vac- 
ciriation. 

DR.  AZURDIA.  I  completely  agree  with  Dr.  Roberts  from  a  technical 
point  of  view,  since  we  should  be  familiar  with  technical  terms,  and  es- 
pecially concerning  the  administrative  branch  of  the  Government,  but 
from  the  point  of  view  of  the  layman,  I  believe  that  in  order  to  under- 
stand the  exact  meaning  of  re-vaccination,  that  this  familiar  term  be 
used. 

It  is  precisely  for  the  purpose  of  obtaining  the  results  suggested  by 
Dr.  Gutierrez  that  I  insist  in  the  use  of  said  common  familiar  terms. 
We  do  not  wish  to  specify  that  there  shall  be  re-vaccination  after  eight 
or  ten  years,  simply  because  if  we  are  going  to  wait  that  long,  because 
in  an  outbreak  of  smallpox  said  provision  would  be  of  no  avail. 
DR.  GUITERAS.  The  fifth  recommendation  reads : 

To  recommend  to  the  American  governments  the  advisability  of  prescribing 
compulsory  vaccination  against  smallpox. 

It  seems  to  me  that  this  fully  covers  the  ground. 


94  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

DR.  ROBERTS.  Then,  it  behooves  each  country  to  prescribe  in  its  laws 
the  period  of  time  that  shall  intervene  from  one  vaccination  to 
another. 

DR.  GUITERAS.  The  Chairman  requests  me  to  ask  whether  article 
V  shall  be  modified  or  remain  as  it  now  stands. 

DR.  PAYAN.    I  move  that  the  article  remain  just  as  it  now  stands. 

DR.  GUITERAS.  The  Chairman  understands  that  the  majority  of  the 
delegates  is  in  favor  of  said  article  remaining  just  as  it  has  been  drafted, 
and  therefore  requests  that  it  be  approved.  (The  article  was  ap- 
proved. ) 

Dr.  Guiteras  then  read  the  following  proposition  made  by  the  Chilean 
Delegation : 

Whereas,  The  international  prophylaxis  of  tuberculosis  so  far  as  it  concerns 
navigation  and  railway  transportation,  should  be  the  result  of  the  perfect 
interior  organization  of  countries  in  their  systematic  struggle  against  said 
disease,  the  Third  International  Sanitary  Convention  recommends  'to  the 
Governments  of  the  nations  here  represented  the  general  employment  of  the 
sanitary  measures  against  the  invasion  of  said  disease. 

(The  proposition  was  approved.) 

DR.  PAYAN.  I  have  requested  the  floor  simply  to  give  my  vote  to  said 
proposition.  It  seems  to  me  that  a  country  can  not  demand  sanitary 
measures  from  other  countries  until  said  country  properly  observes 
them  itself.  Therefore,  in  order  to  demand  that  international  prophy- 
laxis be  enforced  at  all  ports,  the  country  in  interest  should  have  the 
elements  necessary  to  enforce  said  rules.  Therefore,  I  approve  said 
proposition. 

(At  this  moment  Doctors  Liceaga  and  Ulloa  returned  and  took 
charge  of  their  respective  posts.) 

DR.  WYMAN.  Mr.  President,  I  have  received  a  telegram  this  morn- 
ing from  Rome,  Italy,  from  the  American  representative  in  Rome 
appointed  by  the  Government  of  the  United  States  to  meet  the  other 
representatives  from  other  countries,  in  order  to  form  the  International 
Sanitary  Bureau  of  Paris. 

The  International  Sanitary  Convention  agreed  to  at  Paris  provided 
that  later  delegates  should  be  sent  to  Rome  to  organize  the  Inter- 
national Sanitary  Bureau  at  Paris.  Among  the  delegates  sent  to  Rome 
was  one  from  the  United  States,  Dr.  McLaughlin,  and  in  giving  him 
his  instructions  I  directed  him  informally  to  convey  to  the  members 
present  at  that  conference  the  resolutions  passed  at  Rio  concerning 
the  intercommunication  between  the  International  Sanitary  Bureau 
of  Washington  and  the  International  Sanitary  Bureau  at  Paris.  I 
have  a  telegram  from  Dr.  McLaughlin  which  I  would  like  to  read, 
showing  that  evidently  the  President  of  the  International  Sanitary 
Bureau  of  Paris  is  in  hearty  accord  with  the  idea  of  intercommunica- 
tion between  the  two  bureaus : 

Cablegram. — Rome,  Dec.  6,  1907. — General  Walter  Wyman,  American  Em- 
bassy.— Mexico. — Resolution  3  D  Rio  Conference  1906  read  here.  President 
expressed  pleasure  of  this  Conference  with  same  and  stated  no  doubt  existed 
that  la  Office  International  de  Hygiene  Publique  dc  Paris  may  communu -ate 
directly  with  Washington  bureau  as  with  Sanitary  authorities  of  country  adhering 
to  Rome  Convention.— McLaughlin,  Hitt. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  95 

THE  SECRETARY.  The  President  desires  to  know  if  this  Conference  is 
in  session  yet  at  Rome.  • 

DR.  WYMAN.  They  are  meeting  this  month  to  form  the  International 
Sanitary  Bureau ;  they  are  probably  in  session  now. 

THE  CHAIRMAN.  Gentlemen :  The  cablegram  which  Dr.  Wyman  has 
just  read  to  us  shows  the  solidarity  existing  at  this  moment  in  all  the 
nations  of  the  earth  to  accomplish  a  common  purpose.  In  order  to  pre- 
vent an  evil,  the  first  thing  to  be  done  is  to  know  what  it  is,  and  the 
only  way  to  detect  it  is  through  the  bureaus  that  are  established  in  all 
parts  of  the  world.  The  last  convention  established  three  bureaus  in 
order  to  furnish  the  necessary  information,  namely,  those  of  Paris, 
Washington  and  Montevideo,  and  if  the  Rome  conference  is  still  in 
session,  I  would  suggest  that  our  Convention  cable  it,  through  our 
Minister  at  that  capital,  manifesting  the  pleasure  of  the  Third  Inter- 
national Sanitary  Convention  in  approving  the  purposes  of  that  bu- 
reau, whose  aims  are  identical  with  ours.  (Applause.) 

Dr.  Wyman  has  stated  to  me  confidentially  that  the  cablegram  was 
not  sent  him  officially,  but  I  believe  that  it  can  also  be  said  confidentially 
that  the  Convention  has  listened  with  pleasure  to  the  reading  of  said 
cablegram. 

THE  SECRETARY.  As  was  said  before,  the  proposition  of  Dr.  Rob- 
erts was  not,  by  a  mistake  of  mine,  included  in  the  report.  Dr.  Roberts 
will  now  read  it. 

DR.  ROBERTS  (Reading)  : 

The  object  of  the  Conventions  of  the  American  Republics  being  to  render  uni- 
form quarantine  regulations  in  order  to  protect  public  health,  causing  at  the 
same  time  as  little  injury  as  possible  to  commerce,  and 

Whereas,  owing  to  the  lack  of  uniformity  in  the  bills  of  health  issued  by  the 
different  nations  of  America,  it  becomes  difficult  to  fully  understand  the  same 
because  they  many  times  lack  certain  details,  the  undersigned  delegate  proposes : 

1.  That  at  the  next  International   Sanitary  Congress  the  forms  of  bills  of 
health  to  be  issued  by  the  nations  that  have  adhered  to  this  Convention  be  dis- 
cussed and  approved,  in  order  to  verify  the  aforesaid  documents. 

2.  That  at  all  ports  open  to  foreign  commerce,  the  sanitary  authorities  shall 
issue  bills  of  health  to  all  vessels  applying  for  them,  and  in  accordance  with 
such  model  form  as  the  next  Convention  may  adopt. 

THE  SECRETARY.  Inasmuch  as  owing  to  the  short  time  we  had  at  our 
disposal  these  resolutions  were  not  considered  by  the  Advisory  Com- 
mittee, they  will  now  be  discussed.  Shall  they  be  adopted  ? 

(They  were  approved.) 

The  propositions  submitted  by  the  Chilean  delegation  and  the  last 
ones  submitted  by  Dr.  Wytnan  were  likewise  approved,  and  these,  as 
well  as  those  of  Dr.  Roberts,  were  added  to  the  resolutions  adopted 
and  submitted  by  the  Advisory  Committee. 

THE  CHAIRMAN.  The  Secretary  will  now  give  an  account  of  the 
visit  we  have  just  made  to  the  President  of  the  Republic,  the  object 
of  which  was  to  present  the  congratulations  suggested  by  the  delegate 
of  Uruguay. 

THE  SECRETARY.  I  take  pleasure  in  reporting  on  the  mission  which, 
together  with  the  Chairman  of  this  assembly,  was  entrusted  to  us  by 
the  Congress  at  the  previous  session  relating  to  the  congratulations 
which  said  Assembly  had  decided  to  present  to  the  President  of  Mexico 
for  the  important  sanitary  works  that  have  been  carried  out  in  this 


g6  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

country.  General  Diaz  requested  us  to  express  his  deep  acknowledg- 
ment for  this  testimony  of  appreciation  on  the  part  of  this  Congress, 
and  that  all  he  had  done  in  that  respect  was  simply  to  second  what 
Dr.  Liceaga  had  recommended.  During  said  visit  the  President  of 
the  Republic  added  that  he  would  always  keep  as  an  inestimable 
memento  the  communication  in  which  he  was  advised  of  the  resolu- 
tion adopted  by  the  Third  International  American  Sanitary  Conven- 
tion, and  which  the  speaker,  together  with  the  Chairman  of  said  Con- 
vention delivered  to  that  high  functionary  on  that  occasion. 

The  delegates  proposed  a  vote  of  thanks  to  Dr.  Liceaga  for  the  great 
impetus  he  has  given  to  the  sanitation  of  the  ports  and  of  the  capital 
of  Mexico,  and  congratulates  the  administration  of  General  Diaz  for 
the  most  important  works  accomplished  along  those  lines. 

DR.  GUTIERREZ  LEE.  I  beg  to  submit  the  following  proposition  to  the 
delegates : 

Whereas  the  sessions  of  this  Convention  are  about  to  close,  and  after  hearing 
what  the  President  of  the  Republic  has  said  in  praise  of  our  illustrious  Chair- 
man, I  believe  that  all  the  delegates  should  present  a  token  of  our  respect  and 
admiration  to  the  indefatigable  scientific-worker,  Dr.  Liceaga,  our  present  Chair- 
man. As  you  have  already  seen,  his  name  is  associated  with  all  that  progress, 
all  those  hospitals,  all  those  centers  of  sanitation,  not  only  of  the  Federal  Dis- 
trict, but  of  the  whole  Republic,  to  which  he  has  devoted  his  great  learning. 
Therefore,  I  propose  that  this  Convention  present  a  testimonial  of  admiration 
and  respect  to  the  Chairman,  who  honors  us  with  his  presence  on  this  occasion. 
(Great  applause.) 

THE  SECRETARY.  I  have  the  honor  to  second  the  proposition  present- 
ed by  the  delegate  of  Colombia,  and  to  say  to  the  Convention  that  Dr. 
Gutierrez  Lee,  anticipated  my  wishes,  as  I  had  thought  before  to  speak 
on  the  matter,  and  I  have  now  great  pleasure  in  approving  the  well 
deserved  homage  now  rendered  to  our  worthy  Chairman. 

The  proposition  was  unanimously  adopted.     (Applause.) 

THE  CHAIRMAN.  This  testimony  has  deeply  touched  me,  and  be- 
cause of  this  fact  I  can  not  properly  express  my  gratitude  with  words; 
but  if  what  I  have  done,  which  is  very  little  in  comparison  with  what 
I  should  do,  deserves  your  commendation,  I  declare  that  this  is  the 
greatest  satisfaction  that  I  have  ever  experienced.  (Applause.)  I  re- 
peat my  deep  acknowledgment  for  this  token  of  esteem  to  which  I  do 
not  think  I  am  entitled. 

DR.  SOZA.  Mr.  Chairman:  The  Chilean  delegation  has  the  great 
honor  to  state  that  all  the  sentiments  expressed  by  the  gentlemen  who 
have  just  spoken  are  shared  by  all,  and  like  the  delegate  of  Costa  Rica 
were  about  to  express  them.  I  think  we  should  all  join  in  this  testi- 
monial, since  it  is  the  opinion  of  all,  and  that  we  should  sign  a  testi- 
monial on  parchment  in  order  that  our  Honorable  Chairman  may  keep 
it  as  a  memento.  In  this  way  we  would  unite  our  testimony  in  a 
graphic  and  tangible  manner.  (Applause.) 

The  delegate  of  Uruguay  as  well  as  those  of  the  Central  American 
Republics  cheerfully  second  this  proposition. 

The  delegate  of  Brazil  also  seconded  said  proposition. 

DR.  WYMAN.  The  United  States  will  yield  to  no  one  in  its  apprecia- 
tion of  Dr.  Liceaga's  important  work.  We  are 'his  nearest  neighbors, 
and  have  for  many  years  witnessed  his  earnest  and  brilliant  efforts  in 
behalf  of  hygiene  and  public  health.  Nowhere  has  Dr.  Liceaga  greater 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  97 

admirers  than  in  the  United  States,  and  we  wish  this  statement  to  be 
appreciated  in  all  that  it  applies,  and  we  shall  have  the  greatest  pleas- 
ure in  subscribing  any  document  wherein  said  sentiments  are  expressed. 

It  was  decided  to  appoint  a  committee  composed  of  Doctors  Liceaga 
and  Ulloa  to  deliver  to  the  President  of  Mexico  the  communication 
referring  to  the  resolution  adopted  by  the  Convention  concerning  his 
illustrious  personality. 

DR.  GUITERAS.  The  Cuban  delegation  approves  with  great  satisfac- 
tion the  sentiments  just  expressed. 

DR.  ESTEVES.  Following  the  example  of  my  colleagues,  I  share  the 
sentiments  expressed,  always  admiring  the  Mexican  colossus. 

THE  SECRETARY,  Dr.  Liceaga  gives  me  a  mission  rather  difficult 
to  fulfill.  He  says  he  is  not  able  to  answer  as  he  should  wish  the 
sentiments  expressed  in  his  commendation  because  he  is  deeply  touched, 
a  fact  which  we  easily  realize,  because  all  wise  men  are  modest,  and 
Dr.  Liceaga  can  not  be  an  exception.  The  Dr.  Liceaga  of  the  present 
occasion  reminds  me  of  the  Dr.  Liceaga  whom  I  had  the  honor  to 
meet  at  the  Second  Convention  of  Washington. 

On  a  certain  occasion  in  which,  at  a  dinner  given  to  the  delegates 
by  the  Cuban  Minister,  similar  remarks  were  made  regarding  him, 
and  all  he  was  able  to  do  was  to  stand  up  and  manifest  his  apprecia- 
tion with  tears  in  his  eyes.  Nothing  could  be  more  eloquent  than 
those  tears,  which  I  remember  very  well,  and  can  fully  appreciate, 
what  are  now  the  feelings  of  our  competent  and  beloved  Chairman. 
(Applause.)  Gentlemen-:  Before  the  close  of  the  session,  I  take  the 
liberty  to  request  the  delegates  to  deliver  a  copy  of  the  different  essays 
presented  at  this  convention  so  that  they  may  be  forwarded  to  the 
Bureau  of  the  American  Republics  to  be  filed.  Dr.  Yanes  would 
sincerely  thank  you  for  this  attention.  I  also  wish  to  call  the  attention 
of  the  official  representatives  of  the  Republics  to  the  advisability  of 
suggesting  to  their  respective  Governments  to  put  into  effect  the  provi- 
sions which  have  been  approved  before,  to  the  end  that  funds  be 
provided  for  meeting  the  expenses  that  said  office  may  incur.  This 
matter  should  be  taken  up  at  once  because  the  work  of  publishing  the 
long  essays  relating  to  the  proceedings  of  this  convention  would  require 
considerable  expense,  and  that  you  should  also  take  into  consideration 
at  once  the  proposition  of  Dr.  Wyman  concerning  the  office  and  em- 
ployees of  the  International  Sanitary  Bureau.  I  have  a  list  of  the 
nations  that  have  already  paid  in  full,  of  others  that  have  paid  in  part, 
and  of  those  that  have  forgotten  to  comply  with  this  agreement.  I 
shall  not  read  the  names,  but  the  list  is  at  the  disposal  of  the  delegates 
for  their  information. 

THE  CHAIRMAN.  I  beg  to  remind  the  delegates  that  our  last  ses- 
sion will  take  place  today  at  3  p.  m. 

The  session  adjourned. 

Afternoon  Session. 

The  session  was  called  to  order  at  3  p.  m.  by  Dr.  Liceaga,  Chair- 
man, the  following  members  having  been  present:  Dr.  Oswaldo 
Gongalvez  Cruz,  Dr.  Ricardo  Gutierrez  Lee,  Dr.  Genaro  Payan,  Dr. 
Hugo  Roberts,  Dr.  Juan  Guiteras,  Dr.  Ernesto  Soza,  Dr.  Pedro  L. 


98  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

Ferrer,  Dr.  Juan  Horacio  Esteves,  Dr.  Salvador  Ortega,  Dr.  Jose 
Azurdia,  Dr.  Luis  Lazo-Arriaga,  Lie.  Jose  Algara,  Dr.  Gregorio 
Mendizabal,  Dr.  Ernesto  Fernandez  Espiro,  Dr.  Rodolfo  B.  Gonzalez, 
Dr.  Walter  Wyman,  Dr.  R.  H.  von  Ezdorf,  Dr.  Rhett  Goode,  Dr. 
H.  L.  E.  Johnson,  Dr.  J.  Gatewood,  and  the  Secretary,  Dr.  Juan  J. 
Ulloa. 

The  Secretary  requested  that  the  reading  of  the  minutes  of  the  pre- 
vious meeting  be  dispensed  with  and  that  he  be  authorized  to  prepare 
them  later.  This  request  was  granted. 

In  the  course  of  the  session  said  minutes  were  discussed  and  ap- 
proved. 

THE  CHAIRMAN.  Before  commencing  the  discussion  of  the  matters 
comprised  in  the  program,  the  Secretary  wishes  to  present  a  resolu- 
tion to  this  Congress. 

THE  SECRETARY.  I  proposed  the  following  resolutions,  which  were 
unanimously  approved : 

1.  That  a  Committee  be  appointed  to  give,  in  the  name  of  the  Third  Inter- 
national   Sanitary   Convention,   a   vote   of  thanks  to   His   Excellency   General 
Porfirio  Diaz,  President  of  the  Mexican  Republic,  for  his  important  co-operation 
in  the  success  of  this  Convention. 

2.  That  a  vote  of  thanks  be  extended  to  the  Vice-President,  and  to   the 
Secretaries  of  State,  of  the  Treasury,  and  of  the  Interior  for  the  kind  attentions 
shown  us. 

3.  That  a  vote  of  thanks  be  accorded  to  the  Superior  Council  of  the  Govern- 
ment of  the  Federal  District,  and  to  the  Municipal  Government  of  this  city 
for  the  kind  attentions  they  have   shown  us. 

4.  That  we  sincerely  thank  the   committee   of  ladies   who  have   so   kindly 
waited  on  the  wives  and  friends  of  the  foreign  delegates. 

5.  That  a  vote  of  thanks  be  given  to  the  Superior  Board  of  Public  Health  and 
to  the  Director  of  the  Water  Supply  Works  of  this  City  for  the  valuable  services 
they  have  rendered  us,  and 

6.  That  we  express  to  the  Mexican  delegates  to  this  Convention  our  deep 
appreciation  of  the  exquisite  courtesy  and  the  splendid  manner  in  which  they 
have  welcomed  us  to  their  country. 

Dr.  Wyman  moved  that  the  propositions  made  by  Dr.  Ulloa  be 
unanimously  adopted. 

The  Chair  appointed  Drs.  Johnson,  Gutierrez  Lee,  Fernandez  Es- 
piro, Ferrer,  and  Lazo-Arriaga,  to  convey  to  the  President  of  the 
Mexican  Republic  the  resolution  approved  at  this  session,  and  which 
refers  to  his  distinguished  person. 

THE  CHAIRMAN.  The  selection  of  the  place  for  the  holding  of  the 
next  convention  is  now  in  order. 

DR.  GONQALVEZ  CRUZ,  the  delegate  of  Brazil,  moved  that  the  next 
convention  be  held  in  Costa  Rica.  (ApprovedJ 

THE  CHAIRMAN.  Gentlemen:  The  decision  that  the  convention 
has  just  made  seems  to  me  to  be  of  the  greatest  importance;  that  the 
delegate  of  a  country  as  important  as  is  that  of  Brazil  should  have 
made  this  declaration,  honors  him  who  made  it  as  much  as  it  does  the 
country  from  which  he  comes,  and  this  is  another  proof  that  the  aims 
of  this  Convention  are  entirely  just  and  equitable.  The  most  im- 
portant commercial  and  maritime  nation  is  not  selected,  but,  on  the 
contrary,  the  smallest  of  our  sister  Republics.  I  accept  the  resolution 
proposed  to  the  Convention.  (Applause.) 

THE  SECRETARY.  Gentlemen:     In  the  name  of  the  Republic  and 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  99 

Government  of  my  country,  I  sincerely  thank  you  for  the  great  honor 
you  have  conferred  on  us. 

We  are  a  small  nation,  but  we  shall  see  that  our  good-will  meets 
the  exigencies  of  an  Assembly  as  important  as  this  one  is,  and,  above 
all,  after  conventions  have  been  held  in  the  United  States  and  Mexico. 

Costa  Rica,  gentlemen,  two  years  hence  will  receive  you  with  open 
arms,  and  although  we  have  no  lesson  to  give  you,  you  will  find  there 
a  reception  such  as  is  accorded  to  true  brothers.  (Applause.) 

THE  CHAIRMAN.  This  point  settled,  the  selection  of  the  Chairman 
of  the  Convention  is  in  order.  Permit  me  to  suggest  that  Dr.  Juan  J. 
Ulloa,  of  Costa  Rica,  be  chosen  Chairman  of  the  next  convention  by 
acclamation.  (Approved  by  acclamation.)  (Applause.) 

THE  SECRETARY.  I  am  overwhelmed  with  gratitude  at  the  distinction 
of  which  you  have  made  me  the  object.  Although  I  am  large  in  size, 
I  am  small  in  intelligence  and  scientific  accomplishments,  and,  above 
all,  when  I  am  placed  side  by  side  with  the  giants  Liceaga  and  Wy- 
man,  who  have  preceded  me  in  the  honorable  post  to  which  you  have 
called  me. 

I  appeal  to  your  benevolence  and  earnestly  entreat  you  to  assist 
me  in  discharging  the  duties  of  such  a  difficult  mission,  in  the  fulfill- 
ment of  which  I  can  only  offer  my  willingness  and  the  true  desire 
of  my  heart  to  do  so.  (Applause.) 

THE  CHAIRMAN.  The  program  shows  that  we  should  proceed  to 
the  appointment  provided  for  in  article  4  of  the  provisional  program, 
but  as  this  appointment  was  made  this  morning,  we  will  proceed  to 
the  election  of  the  chairman  and  personnel  of  the  International  Sani- 
tary Bureau  of  the  American  Republics. 

DR.  FERNANDEZ  ESPIRO.  I  move  the  Convention  that  the  Chairman 
and  personnel  of  the  International  Sanitary  Bureau  in  Washington 
continue  the  same  as  it  has  been  heretofore.  (Applause.) 

This  motion  was  unanimously  carried,  and,  therefore,  the  personnel 
of  said  Bureau  is  Drs.  Walter  Wyman,  Eduardo  Liceaga,  Juan  J. 
Ulloa,  Juan  Guiteras,  A.  T.  Doty,  Rhett  Goode  and  Eduardo  Moore. 

THE  CHAIRMAN.  For  my  part  I  sincerely  thank  you  for  the  honor 
you  have  conferred  upon  me  in  continuing:  me  as  a  member  of  that 
Committee. 

THE  SECRETARY.  I  likewise  desire  to  express  my  sincere  thanks  for 
this  honor. 

DR.  WYMAN.  I  also  wish  to  thank  you  for  the  honor  of  having 
been  again  elected  Chairman  of  the  International  Sanitary  Office,  and 
to  express  my  deep  gratitude  for  this  honor. 

THE  CHAIRMAN.  This  phrase  has  been  placed  in  the  program: 
"Designation  of  the  authority  which  is  to  issue  the  invitations  to  that 
Convention."  As  we  have  already  said  a  number  of  times  in  this 
Convention  this  reunion  was  born  at  the  Pan-American  Conference 
held  in  Mexico  during  the  latter  part  of  1901  and  the  early  part  of 
1902,  and  the  5th  clause  of  that  conference  says: 

"V.  The  Second  International  Conference  of  the  American  States  further 
recommends,  in  the  interest  of  the  mutual  benefit  that  would  be  derived  there- 
from by  each  of  the  American  Republics,  and  that  they  may  more  readily  and 
effectively  co-operate  one  with  the  other  in  all  matters  appertaining  to  the 
subiects  mentioned  in  the  above  resolutions,  that  a  general  convention  of  the 


IOO  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

health  organizations  of  the  different  American  Republics  shall  be  called  by 
the  governing  board  of  the  International  Union  of  American  Republics  to  meet 
at  Washington,  D.  C,  within  one  year  from  the  date  of  the  adoption  of  these 
resolutions  by  this  conference;  that  each  Government  represented  in  this  con- 
ference shall  designate  one  or  more  delegates  to  attend  such  convention;  that 
authority  shall  be  conferred  by  each  Government  upon  its  delegates  to  enable 
them  to  join  delegates  from  the  other  Republics  in  the  conclusion  of  such 
sanitary  agreements  and  regulations  as  in  the  judgment  of  said  convention 
may  be  in  the  best  interests  of  all  the  Republics  represented  therein;  that 
voting  in  said  convention  shall  be  by  Republics,  each  Republic  represented 
therein  to  have  one  vote ;  that  said  convention  shall  provide  for  the  holding 
of  subsequent  sanitary  conventions  at  such  regular  times  and  at  such  places 
as  may  be  deemed  best  by  the  convention ;  and  that  it  shall  designate  a  permanent 
executive  board  of  not  less  than  five  members,  who  shall  hold  office  until  the 
next  subsequent  convention,  at  which  time  the  board  shall  be  appointed  with  a 
chairman  to  be  elected  by  ballot  by  the  convention;  that  said  executive  board 
shall  be  known  as  the  'International  Sanitary  Bureau,'  with  permanent  head- 
quarters at  Washington,  D.  C." 

It  has  been  customary  for  the  Bureau  of  the  American  Republics 
to  call  the  Convention,  and  that  was  the  method  adopted  with  regard 
to  the  first  two  conventions,  and  no  objections  were  made,  but  since 
the  Convention  had  to  meet  out  of  Washington,  then  the  departments 
of  foreign  relations  of  all  the  Republics  made  the  following  objection: 
That  there  was  no  doubt  as  to  the  authority  the  Bureau  of  the  Ameri- 
can Republics  had  to  make  the  call,  but  that  it  seems  an  act  of  national 
courtesy  that  the  Republic  in  which  the  convention  was  to  be  held 
should  issue  the  invitations,  and  for  this  reason  it  will  be  remembered 
that  the  Mexican  Republic  issued  the  invitations  to  this  Convention 
through  its  Department  of  Foreign  Relations. 

Inasmuch  as  our  purpose  is  that  all  our  decisions  shall  be  of  a 
practical  character,  I  would  beg  to  request  you  that  the  Bureau  of 
the  American  Republics  make  the  call,  and  that,  in  addition,  the  Gov- 
ernment of  the  country  where  the  Convention  is  to  be  held  issue  an  in- 
vitation through  its  department  of  foreign  relations  to  the  several  coun- 
tries represented. 

DR.  WYMAN  stated  that  this  was  the  desire  of  the  convention. 

DR.  JOHNSON  seconded  the  motion. 

DR.  LAZO  ARRIAGA.  I  entirely  agree  with  the  motion  of  the  Chair- 
man, and  would  like  for  all  of  us  to  adopt  it. 

THE  CHAIRMAN.  This  matter  having  been  decided,  and  as  no  one 
wishes  to  make  any  remarks  to  the  contrary,  I  would  like  for  the 
Convention  to  fix  the  date  of  the  meeting  of  the  next  Convention. 

THE  SECRETARY.  I  suggest,  Mr.  Chairman,  that  on  considering  the 
date  the  Convention  is  to  be  held  and  on  deciding  the  same,  a  date  as 
close  to  the  25th  of  December  as  possible  should  be  chosen,  because  that 
is  the  best  season  of  the  year  in  San  Jose,  with  the  advantage  that, 
after  the  work  of  the  Convention  is  over,  the  delegates  may  enjoy 
the  civic  festivities  which  will  take  place  in  said  city  on  the  3Oth  and 
3  ist  of  December,  and  the  ist  of  January. 

THE  CHAIRMAN.  Inasmuch  as  the  duty  of  this  assembly  is  to  fix 
only  an  approximate  date,  it  devolves  on  the  Bureau  of  the  American 
Republics  to  fix  the  precise  date,  with  the  approval  of  the  new  Chair- 
man. I  believe  that  the  resolution  could  be  worded  in  the  following 
manner:  "To  be  held  in  December,  1909." 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  IOI 

If  no  one  wishes  to  make  any  remarks,  we  shall  consider  this  reso- 
lution approved.  It  was  approved. 

Let  us  now  carry  out  the  last  part  of  our  program. 

I  have  the  pleasure,  gentlemen,  of  announcing  to  you  that  the  next 
person  who  is  entitled  to  the  floor  is  Dr.  Gongalvez  Cruz,  delegate  of 
Brazil,  a  very  modest  gentleman,  whose  merits  I  refrain  now  from 
stating,  fearing  that  he  would  be  embarrassed  thereby.  Still,  I  will 
say  that  in  sanitary  matters  he  occupies  one  of  the  first  places  in  Brazil, 
and  I  have  the  greatest  pleasure  in  introducing  him  to  you,  if  such 
introduction  is  necessary,  since  he  has  an  international  reputation. 

DR.  GONQALVEZ  CRUZ.  Mr.  Chairman  and  delegates:  On  leaving 
you  today,  I  feel  it  my  imperative  duty  to  express  my  acknowledgment 
to  this  hospitable  and  progressive  country  for  the  kind  and  fraternal 
reception  accorded  us. 

I  congratulate  myself  and  all  my  colleagues  on  the  many  advantages 
derived  from  the  exchange  of  views  that  we  have  experienced  here, 
and  which  all  of  us  will  carry  with  us  to  our  native  countries,  con- 
tributing in  this  joint  manner  to  a  unity  of  views  and  agreement  in  all 
matters  relating  to  sanitation. 

I  shall  always  retain  the  most  pleasant  recollections  of  these  few 
days,  and  Brazil  is  deeply  indebted  for  the  kind  and  courteous  at- 
tentions of  each  and  every  one  of  the  members  of  this  assembly. 

Nothing  could  describe  the  eloquent  and  brilliant  manifestations 
accorded  the  learned  President  of  the  Supreme  Board  of  Health  of 
Mexico,  and  to  our  esteemed  Chairman  I  bring  the  homage  of  deep 
gratitude  for  the  paternal,  kind  and  able  manner  in  which  he  has  di- 
rected our  work,  and  who  has  encouraged  us  with  his  example  of 
untiring  diligence.  My  esteemed  colleagues,  I  bid  you  farewell. 

THE  CHAIRMAN.  I  have  the  honor  to  introduce  to  you  Dr.  Ricardo 
Gutierrez  Lee,  representative  of  Colombia.  He  has  been  our  com- 
panion in  all  our  work  of  this  kind.  He  is  one  of  the  most  enthusiastic 
members  in  sanitary  matters,  and  since  he  would  not  make  any 
remarks,  I  did  not  wish  to  deprive  myself  of  the  satisfaction  of  inform- 
ing you  that  I  have  known  him  for  a  long  time,  not  only  as  a  distin- 
guished gentleman,  but  also  as  an  able  member  of  our  conventions. 

At  the  same  time  I  have  the  pleasure  to  introduce  to  you  Dr. 
Payan,  who  is  the  Benjamin  of  this  Congress,  and  who  has  already 
shown  us  his  great  ability  in  his  report. 

DR.  PAYAN.  Mr.  President  and  Delegates:  I  am  deeply  grateful 
for  the  kind  words  of  the  Chairman. 

In  the  name  of  my  Government  and  in  that  of  the  Colombian  Dele- 
gation, I  have  the  great  honor  of  expressing  our  deep  gratitude  to  the 
Mexican  Government  and  Delegation  to  the  Third  International  Sani- 
tary Convention  for  the  constant  proofs  of  sympathy  shown  us,  thus 
rendering  more  lasting,  if  that  could  be  possible,  the  pleasant  re- 
membrances which  all  of  us  shall  keep  of  the  pleasant  days  we  have 
spent  in  this  beautiful  capital  of  this  great  Republic  where  we  have 
seen  a  true  progress  and  over  which  floats  as  a  halo  of  peace,  the 
illustrious  figure  of  General  Diaz. 

I  would  also  express  my  acknowledgment  to  the  distinguished  Chair- 
man of  our  Convention  for  the  kind  manner  in  which  he  has  treated 
us.  We  have  seen  this  morning  that  the  nations  of  the  American  con- 


102  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

tinent  here  represented  gave  him  a  testimony  of  their  admiration, 
which  he  well  deserves  because  of  his  great  work  in  behalf  of  the 
progress  of  his  country,  and  when  the  continuation  of  the  Pan-Ameri- 
can Conventions  was  proposed,  he  pointed  out  the  best  way  of  uniting 
all  the  peoples  of  this  Continent. 

Concerning  this  matter  I  believe  that  if  we  have  not  entertained  a 
more  favorable  opinion  of  ourselves,  it  is  because  we  have  not  known 
each  other  well  enough.  If  we  have  not  made  ourselves  understood 
mutually,  it  is  because  the  isolation  in  which  we  have  lived  has  not 
permitted  us  to  banish  the  prejudices  and  discover  the  capability  and 
good  faith  that  obtain  among  us.  By  our  mutual  intercourse  we  dis- 
cover that  from  all  points  of  view  our  opinions  are  not  widely  differ- 
ent, much  less  indeed  than  we  suspect.  A  better  understanding,  and 
a  greater  and  clearer  conception  of  our  mentality  and  moral  purpose, 
is  what  those  who  aspire  to  the  creation  of  Panamericanism,  that  is 
to  say  a  true  Pan-American  solidarity,  should  endeavor  to  bring  about. 
(Applause.) 

THE  CHAIRMAN.  I  have  the  honor  to  introduce  to  you  a  person 
who  needs  no  introduction  to  this  assembly,  Dr.  Guiteras,  of  Cuba. 
The  name  of  Dr.  Guiteras  is  so  closely  associated  with  our  work  in 
the  sanitary  congresses,  and  with  this  Third  Convention,  that,  as  Presi- 
dent Diaz  said,  when  I  introduced  Dr.  Guiteras  to  him,  "his  name  is 
well  known  in  connection  with  the  doctrine  of  the  transmission  of 
yellow  fever."  Indeed,  if  Dr.  Guiteras  has  not  so  many  qualifications 
which  entitle  him  to  the  respect  of  the  scientific  world,  and  of  the 
whole  world,  it  would  suffice  for  him  to  have  associated  his  name  with 
the  great  discovery  which  has  completely  revolutionized  the  knowl- 
edge we  had  concerning  yellow  fever. 

DR.  GUITERAS.  I  am  exceedingly  grateful  for  the  kind  congratu- 
lations from  Dr.  Liceaga,  and  Dr.  Roberts  will  take  the  floor  to  bid 
farewell  to  our  colleagues. 

THE  CHAIRMAN.  I  congratulate  myself  on  my  mistake,  because 
thereby  I  will  have  the  pleasure  to  say  publicly  what  I  have  said 
in  private.  Dr.  Roberts  also  deserves  great  credit;  he  is  the  Chief 
of  the  Sanitary  Service  of  Cuba,  and  has  shown  us  his  great  learning 
both  in  the  part  he  has  taken  in  our  discussions,  and  in  the  propositions 
he  has  submitted,  all  of  which  are  eminently  practical. 

DR.  ROBERTS.  Mr.  Chairman:  It  is  the  duty  of  every  civilized 
man  to  do  all  that  he  possibly  can  in  behalf  of  his  fellow  beings, 
and  this  being  the  mission  that  has  brought  about  our  meeting,  we 
ought  to  be  satisfied  for  having  endeavored  to  contribute,  with  the 
greatest  enthusiasm,  in  carrying  out  our  great  purpose.  I  sincerely 
wish  that  the  ties  of  union  established  by  this  Convention  among  all 
the  nations  of  America,  to  which  Mexico  has  greatly  contributed, 
may  be  closer  every  day,  and  that  this  union  may  prove  to  be  the 
foundation  of  a  fraternal  feeling  among  all  the  people  of  the  New 
World. 

THE  CHAIRMAN.  Dr.  Juan  J.  Ulloa,  another  gentleman  who  is 
unknown  to  you,  will  now  have  the  floor.  This  unknown  gentleman 
is  one  of  the  veterans  in  sanitary  works,  from  the  time  we  earnestly 
undertook  such  work,  and  he  has  shown  his  constant  desire  that  these 
conventions  may  not  be  given  up,  and,  in  addition  to  his  scientific  at- 


THIRD   INTERNATIONAL    SANITARY    CONVENTION.  IO3 

tainments,  and  which  he  disowns  through  modesty,  he  possesses  a 
proverbial  kindness,  and  will  therefore  constitute  a  true  bond  of  union 
for  future  congresses,  especially  now  that  he  has  been  elected  Chair- 
man of  the  next  convention  that  will  be  held  in  San  Jose  de  Costa 
Rica. 

THE  SECRETARY.  Before  beginning  my  remarks,  let  me  embrace  my 
old  friend  and  distinguished  teacher,  Dr.  Eduardo  Liceaga.  Being 
about  to  leave  this  noble  and  progressive  land  where  we  have  been 
shown  so  many  courtesies,  and  where  we  have  been  treated  in  a  royal 
manner,  I,  in  the  name  of  Costa  Rica,  and  of  its  government,  sincerely 
thank  the  government  of  His  Excellency,  General  Diaz,  I  thank  the 
learned  descendants  of  the  brave  Aztecs,  the  government  of  the  Fed- 
eral District,  and  our  colleagues  the  delegates  of  this  enlightened 
country. 

May  the  progress  which  has  been  so  rapidly  made  in  Mexico,  con- 
tinue its  forward  march  until  the  sister  of  which  we  are  proud  is  lost 
sight  of  in  the  splendid  horizon  of  the  2Oth  Century.  Farewell,  my 
dear  colleagues,  until  we  meet  again ;  when  you  arrive  in  the  bosom  of 
my  country,  I  shall  have  the  pleasure  of  according  you  the  most  cor- 
dial welcome.  (Applause.) 

THE  CHAIRMAN.  Gentlemen:  Dr.  Ferrer,  delegate  of  Chile,  has 
kindley  consented  to  make  some  remarks.  Though  he  is  young,  as  you 
see,  he  has  already  attained  eminence  in  his  profession,  and  is  well 
known  not  only  in  his  country,  but  in  all  America,  and  I  take  great 
pleasure  in  introducing  him  to  you  as  one  of  the  prominent  men  of 
his  Republic. 

DR.  FERRER.  Mr.  Chairman  and  Delegates:  The  Chilean  delega^ 
tion  on  taking  leave  of  the  Convention  assures  to  the  Mexican 
nation  its  most  genuine  and  cordial  support,  and  thanks  His  Excel- 
lency, General  Porfirio  Diaz,  President  of  the  Republic,  for  his  kind 
and  benevolent  observations  made  concerning  our  country,  and  ex- 
presses to  the  Honorable  Chairman  of  the  Third  International  Sani- 
tary Convention  of  the  American  Republics,  Dr.  E.  Liceaga,  its  most 
respectful  and  sincere  sentiments  of  admiration  at  the  excellent  man- 
ner in  which  he  has  fulfilled  his  scientific  duties,  the  discreet  way  in 
which  he  presided  over  the  proceedings  of  this  Convention,  and,  above 
all,  at  his  goodness  of  heart  and  his  spirit  of  fraternalism  to  each  and 
every  one  of  our  colleagues. 

It  is  most  gratifying  to  the  Chilean  Delegation  to  grasp  the  hands, 
on  this  solemn  occasion,  of  its  colleagues  of  the  American  Republics, 
manifesting  to  them  the  solidarity  of  our  sentiments  in  our  difficult 
tasks,  and  to  acknowledge  that  the  highest  confraternity,  the  calmest 
discussion,  and  the  most  noble  spirit  of  American  union  has  always 
pervaded  this  atmosphere. 

THE  CHAIRMAN.  The  representative  of  Ecuador,  Dr.  Esteves.  I 
regret  very  much  that  I  should  not  have  had  occasion  to  learn  of  his 
excellent  attainments,  but  his  innate  modesty  has  constantly  obscured 
them.  Nevertheless,  from  private  conversations  had  with  him,  I  am 
convinced  of  his  nobleness  of  spirit,  and  of  his  desire  to  carry  the 
work  of  the  Convention  to  a  successful  termination. 

DR.  ESTEVES.  Mr.  Chairman:  The  Republic  of  Ecuador,  which 
hastened  to  accept  the  invitation  of  the  Mexican  Government  to 


IO4  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

attend  the  Third  International  Sanitary  Congress,  has  again  mani- 
fested on  this  occasion  its  desire  to  offer  its  modest  contingent  to 
all  that  tends  to  more  closely  unite  the  American  Republics,  not 
only  with  respect  to  their  political  relations  and  diplomatic  friend- 
ship and  good-will  between  the  Governments,  but  also  in  all  that  signi- 
fies progress,  reciprocal  usefulness,  the  interchange  of  views,  and  the 
application  of  general  rules  to  the  welfare  of  the  Continent. 

You  will  remember  that  the  first  convention  dealt  almost  exclusively 
with  hygienic  questions,  and  in  this  matter  it  is  an  honor  for  me  to 
accept  your  authorized  opinions  for  the  purpose  of  proclaiming  at 
your  side  the  supremacy  of  hygiene  over  medicine — notwithstanding 
our  professional  partiality — as,  even  in  the  judgment  of  learned  mili- 
tary leaders,  the  humanitarian  provisions  suggested  with  the  object 
of  regulating  and  civilizing  war,  and  the  generous  efforts  that  civilized 
nations  have  made  to  avoid  strife,  are  likewise  preferable  in  matters 
relating  to  warfare. 

One  of  the  positive  advantages  of  sanitary  congresses  is  that  it  can 
be  said  of  them  that  all  their  members  are  of  accord  beforehand,  and 
no  essential  difference  can  arise  in  the  estimation  of  the  methods  that 
it  is  fitting  to  adopt,  for  the  purpose  of  efficiently  combating  the  most 
terrible  and  sanguinary  enemies  of  the  human  species.  Innumerable 
benefits  having  already  been  obtained  in  the  union  of  27  nations  under 
the  provisions  of  one  Sanitary  Code,  and  it  being  logical  to  hope 
that  the  fraternal,  farseeing  and  redeeming  propaganda  is  not  to  be 
stopped  within  the  limit  already  reached,  a  day  will  come  when  un- 
just prejudices  will  be  banished  and  difficult  obstacles  swept  away 
by  universal  union  under  one  flag — the  flag  of  Science  for  the  Health 
and  Life  of  Men — that  could  easily  cover  all  the  countries  of  the  earth 
as  well  as  the  realms  of  heaven. 

The  eloquent  examples  that  you  have  cited  relating  to  the  wonderful 
success  obtained  in  Mexico  in  the  extirpation  of  yellow  fever,  as  well 
as  a  comparative  review  of  the  ravages  of  the  plague  in  India,  the 
almost  barren  results  of  the  recent  invasion  of  the  cholera  in  Europe, 
and  the  prodigious  effect  of  the  antiseptic  system  used  by  the  Govern- 
ment of  the  United  States  in  Habana,  show  in  the  most  conclusive 
manner  how  certain  are  the  truths  you  have  established  as  to  the 
immense  benefits  of  hygiene,  and  how  much  more  efficacious  is  the 
sanitation  of  towns  at  the  present  time  than  was  the  ancient  and 
odious  regime  of  quarantines  that  will  soon  be  abolished  everywhere. 

We  can  now  congratulate  ourselves  that  the  provisions  of  the  Con- 
vention of  Washington  of  1905,  which  have  been  in  force  in  Ecua- 
dor, should  have  been  unanimously  accepted,  with  slight  modifica- 
tions, by  this  conference,  and  it  only  remains  for  us  to  desire  that 
these  provisions  be  the  basis  of  a  code  of  international  sanitary  police 
regulations  in  all  the  countries  of  the  New  World. 

I  am  pleased  to  acknowledge  that  the  agreements  of  this  Conven- 
tion are  of  undeniable  importance  and  are  worthy  the  high  purpose 
that  caused  us  to  assemble  here,  and  I  promise  that  they  shall  be 
faithfully  observed  by  the  country  that  I  represent. 

In  conclusion  I  am  deeply  indebted  to  the  Mexican  Government  and 
to  you  for  the  kind  reception  you  have  given  me,  and  I  now  convey  to 
the  Government  and  people  of  the  United  States  of  Mexico,  the 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  IO5 

friendly  greetings  of  the  People  and  Government  of  Ecuador,  and 
avail  myself  of  this  opportunity  to  publicly  express  the  cordial  feelings 
of  admiration  and  respect  which  General  Eloy  Alfaro,  President  of 
the  Republic  of  Ecuador,  entertains  for  the  illustrious  General,  Por- 
firio  Diaz,  whom  the  whole  world  admires  for  his  statesmanship  as 
well  as  for  his  civic  virtues. 

THE  CHAIRMAN.  Dr.  Azurdia  is  not  only  one  of  the  most  distin- 
guished physicians  of  his  country,  but  also  a  well  known  poet,  having 
shown  his  great  attainments  whenever  he  has  had  the  floor;  but  what 
renders  the  presence  of  the  Guatemalan  Delegation  of  the  utmost  im- 
portance is  the  spirit  of  confraternity  that  it  has  constantly  shown 
ever  since  we  commenced  to  hold  our  sessions,  and  the  great  clearness 
of  its  views  in  the  matters  in  which  it  has  taken  part.  Therefore,  I 
take  pleasure  in  introducing  to  you  Dr.  Azurdia,  who  will  now  have 
the  floor. 

DR.  AZURDIA.  Mr.  Chairman  and  Delegates:  We  shall  leave  this 
Capital,  but  the  memories  of  this  Convention  will  remain  indelibly 
engraved  in  our  minds  and  hearts  as  an  event  of  the  utmost  import- 
ance. In  our  minds,  because  of  the  comprehensive  scientific  work 
carried  out  in  sanitary  matters  in  the  ports  and  cities  of  the  Republic 
of  Mexico.  We  had  occasion  to  admire  the  General  Hospital  which 
can  compare  favorably  with  the  best  hospitals  of  the  world,  the  water 
supply  works  of  this  city,  expensive  and  magnificent,  the  important 
system  of  sewerage  and  drainage,  and  the  institution  devoted  to  the 
rehabilitation  and  moral  improvement  of  criminals,  namely,  the  beau- 
tiful penitentiary  of  Mexico. 

We  have  had  also  occasion  to  admire  the  means  of  communication, 
the  great  commerce,  the  wonderful  industries  developed  at  Rio  Blanco 
in  the  weaving  and  spinning  mills*  the  great  general  progress  in  all  the 
spheres  of  human  activity  that  is  being  carried  out  in  the  Republic. 
And,  consequently,  we  have  realized  that  such  results  obtained  from 
science  when  applied  to  hygiene,  have  in  Dr.  Liceaga  an  untiring 
director,  as  those  which  the  nation,  as  a  whole,  has  obtained  in  com- 
plicated economic-administrative  affairs,  have  their  ablest  representa- 
tive— their  alma-mater — in  the  President  of  the  Republic.  On  the 
other  hand,  thanks  to  the  gallant  courtesy  of  Dr.  Liceaga,  we  have 
also  been  able  to  admire,  not  only  the  flowers  which  with  immense 
profusion  embellish  these  beautiful  fields,  not  only  the  panoramic  views 
of  this  unique  valley,  but  also  the  fire  of  the  eyes  of  the  beautiful  Mex- 
ican ladies  whose  magnetism  has  entirely  fascinated  us. 

And  add  to  all  this,  gentlemen,  the  work  of  the  Convention,  which 
will  doubtless  be  beneficial  to  all  America,  has  shown  us  that  the 
solidarity  of  the  people  of  the  New  World  so  far  as  ideals,  aspirations 
and  sympathies  are  concerned  is  a  possible  and  real  fact. 

In  a  word,  is  it,  perchance,  necessary  to  speak  of  hospitality  in  a 
sister  republic,  wherein  prevail  the  same  tendency  toward  progress, 
advancement  and  education  as  those  which  obtain  in  my  beloved 
Guatemala?  Why  should  we  speak  of  hospitality  in  a  country  like 
this  universally  known  for  its  nobleness,  beautiful  because  of  the  learn- 
ing of  its  men  and  the  refinement  of  its  social  circles  ?  We  will  soon 

meet  again,  gentlemen.  Tomorrow — in  August  of  next  year we 

shall  hold  in  Guatemala  the  Fifth  Pan-American  Medical  Congress, 


IO6  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

and,  soon  after,  the  Fourth  International  American  Conference  in 
Costa  Rica.  The  Delegates  of  Guatemala  do  not  say  farewell,  we 
give  you  a  hearty  greeting,  humming  an  American  hymn  of  loving 
confraternity  to  Dr.  Liceaga,  Chairman  of  this  Convention,  and  to  the 
President  of  the  Mexican  Republic. 

Gentlemen,  we  will  not  say  adieu  because  the  Government  and  people 
of  Guatemala,  who  sent  you  their  affectionate  greetings  at  the  begin- 
ning of  your  labors,  anxiously  waits  for  you  to  receive  you  with  open 
arms. 

THE  CHAIRMAN.  I  hope  that  Dr.  Wyman,  as  representative  of  the 
United  States,  will  favor  us  with  some  remarks.  Indeed  it  is  unneces- 
sary for  me  to  introduce  General  Wyman,  since  no  person  is  better 
known  than  he  on  the  whole  American  Continent.  The  work  he  has 
undertaken,  and  which  he  has  carried  out  in  his  country,  the  great 
benefits  received  not  only  by  his  native  country,  but  by  all  the  other 
countries  of  the  American  Continent,  but  the  great  knowledge  he  has 
in  matters  relating  to  public  hygiene  and  the  wonderful  organization 
of  the  services  he  has  rendered  to  his  country,  are  really  prodigious, 
and  the  progress  made  by  the  Marine  Hospital  Service  is  equally 
worthy  of  credit.  These  facts  go  beyond  anything  we  can  measure 
with  ordinary  understanding,  inasmuch  as  the  work  he  has  accom- 
plished belongs  to  a  century  rather  than  to  a  short  period  of  time.  I 
take  pleasure  in  expressing  publicly  on  this  occasion  my  admiration 
for  Dr.  Wyman,  who  will  now  take  the  floor. 

DR.  WYMAN.  In  glancing  over  what  ha's  been  done  this  last  week, 
I  believe  that  the  International  American  Sanitary  Convention  has  lost 
nothing  of  its  vigor,  purpose,  and  ability  to  do  things,  but  that  in  all 
these  things  they  have  been  increased  by  the  deliberations  of  the  Con- 
vention which  is  now  about  to  close. 

The  first  Convention,  which  was  held  in  Washington  five  years  ago, 
announced  some  principles  on  which  we  all  agreed,  and  also  estab- 
lished feelings  of  good  will  among  the  delegates. 

All  this  prepared  the  way  for  the  important  event  of  the  second  con- 
vention, which  was  held  two  years  ago,  and  furnished  us  with  a  con- 
crete proposition,  namely,  the  Convention  which  was  proposed  to  our 
respective  governments. 

This  Convention  prepared  some  rules  which  should  serve  as  a  guide 
for  all  the  republics  in  the  treatment  of  bubonic  plague  and  yellow 
fever,  which  have  already  been  recognized  as  international  diseases. 
Almost  all  of  the  Republics  have  adhered  to  this  Convention  by  formal 
approval  or  ratification.  And  now  at  this  Convention  we  have  dis- 
cussed and  prepared  in  concrete  forms  some  additional  sanitary  pro- 
visions which  being  the  formal  and  unanimous  expression  of  all  the 
republics  ought  to  be  of  unquestionable  value  in  the  years  to  come, 
serving  as  the  star  which  shall  serve  as  a  guide  in  the  voyage  of  the 
several  republics  towards  a  perfect  port  of  hygiene  and  sanitation. 
But  again,  in  compliance  with  the  instructions  of  the  Third  Confer- 
ence of  the  American  Republics  held  at  Rio  de  Janeiro  in  1906,  we 
have  taken  measures  tending  to  establish  a  practical  method  of  bring- 
ing perfect  sanitation  to  our  ports.  We  can  not,  at  present,  affirm  that 
we  have  prepared  a  Convention  which  shall  serve  as  the  basis  for 
the  purpose  in  view,  but  we  have  authorized  the  International  Sanitary 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  IO/ 

Office  to  take  this  matter  into  consideration,  and  in  accordance  with  a 
resolution,  all  the  delegates  know  that  this  will  be  one  of  the  questions 
which  will  be  taken  up  and  considered  %at  the  Fourth  Sanitary  Conven- 
tion, which  will  be  held  within  two  years  in  Costa  Rica.  An  Interna- 
tional Convention  concerning  such  sanitation  of  the  port  as  would  pre- 
vent the  plague  from  spreading,  a  disease  which  after  it  is  developed 
spreads  through  all  the  arteries  of  commerce,  is,  doubtless,  a  great 
sanitary  step  forward,  which  would  be  in  consonance  with  the  feelings 
of  modern  fraternity  among  nations.  This  week  has  been  full  of  prac- 
tical lessons,  which  we  have  received  from  this  glorious  Republic  of 
Mexico — lessons  both  of  humanitarianism  and  in  matters  relating  to 
public  health.  We  unanimously  say,  well  done,  Mexico,  well  done, 
Liceaga. 

From  a  social  point  of  view  it  is  very  difficult  for  us  to  be  able  to 
express  properly  our  gratitude  for  the  great  hospitality  and  exquisite 
courtesies  shown  us — all  this  kindness  and  courtesies  have  left  lasting 
remembrances  in  all  our  hearts,  and  in  view  of  these  pleasant  enter- 
tainments, we,  the  foreign  delegates,  have  been  able  to  become  better 
acquainted  with  each  other,  and  have  formed  ties  of  friendship  which 
will  endure  as  long  as  we  live. 

Mr.  Chairman  and  gentlemen:  It  seems  to  me  that  this  beautiful 
group  of  flags  displayed  behind  the  seat  of  the  Chairman,  showing  the 
colors  of  all  the  Republics,  conveys  an  exact  idea  of  our  present  situa- 
tion with  regard  to  our  international  sanitary  conventions.  Those 
flags  are  in  a  group  the  motto  for  which  consists  of  two  words :  "Peace 
and  law !"  What  a  noble  aspiration  is  expressed  in  these  two  words, 
and  how  well  they  harmonize  with  the  purpose  of  our  Convention ! 

The  brilliant  colors  of  these  flags  are  a  symbol  of  beauty  and  power. 
The  white  color  is  found  in  those  flags  to  symbolize  the  purity  and 
the  absence  of  selfishness  in  our  purposes;  the  red  symbolizes  the 
earnestness  with  which  we  endeavor  to  carry  out  our  ideals;  the  blue 
reveals  our  loyalty  and  our  constancy  toward  the  observance  of  our 
principles,  and  all  these  colors  are  grouped  to  form  one  single  flag  or 
symbol.  Such  is  our  situation  today.  May  it  so  continue  for  a  long 
time.  If  the  future  sanitary  conventions  are  inspired  by  the  same  fra- 
ternal feeling,  and  by  the  same  harmony  of  action  and  aims  that  have 
been  shown  in  the  first  and  second  conventions,  and  now  in  this  third 
one,  then  I  am  sure  that  the  American  Republics  and  the  whole  world 
will  have  reason  to  congratulate  themselves  on  the  good  results  which 
will  undoubtedly  be  obtained  because  of  them. 

DR.  GOODE.  We  have  experienced  gr^at  pleasure  during  our  brief 
visit  to  this  great  and  beautiful  city  of  Mexico.  The  Mexican  ladies 
are  as  beautiful  as  they  are  kind,  and  the  cultured  gentlemen  we  have 
had  the  honor  and  satisfaction  of  meeting  are  perfect  types  of  the 
Mexican  race. 

Mankind  will  derive  great  benefits  from  the  work  of  the  Third  In- 
ternational Sanitary  Convention,  and  to  our  Chairman,  Dr.  Liceaga, 
we  are  indebted  for  the  success  of  this  Convention  and  the  happy  hours 
we  have  spent  here. 

THE  CHAIRMAN.  Dr.  Lazo-Arnaga,  Delegate  of  Honduras,  whose 
personal  attainments  I  had  occasion  to  appreciate  during  the  short 


IO8  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

moment  which  our  official  work  left  at  our  disposal,  and  whose  per- 
sonality I  greatly  admire,  will  now  address  you. 

DR.  LAZO-ARRIAGA.  I  want  to  unite  my  voice  to  the  choir  of  praises 
concerning  our  dear  and  learned  Chairman,  and  also  to  thank  the 
enlightened  Mexican  Government  and  the  distinguished  representation 
of  the  city  who  have  co-operated  to  the  end  that  our  stay  in  this 
beautiful  Capital  of  Mexico  may  be  more  pleasant. 

If  we  ever  had  a  reason  for  remembering  a  beautiful  city,  where,  in 
addition  to  the  work  of  man  nature  had  prodigally  contributed  to  its 
embellishment,  and  where  to  this  is  added  the  great  beauty  of  her 
daughters,  we  would  assuredly  point  to  Mexico. 

Before  saying  farewell  to  you,  I  desire  to  thank  each  and  every  one 
of  you  both  for  the  courtesies  which,  as  representative  of  Honduras, 
you  have  shown  me,  and  for  having  appointed  as  the  place  of  meeting 
of  the  next  Convention  one  of  the  Central  American  Republics.  As  a 
Central  American  I  am  deeply  conscious  and  grateful  for  this  honor. 

THE  CHAIRMAN.  Dr.  Mendizabal,  our  countryman,  is  the  represen- 
tative of  Nicaragua,  and  I  hesitate  to  say  anything  in  his  honor  be- 
cause my  love  for  him  is  such  that  it  might  be  construed  that  anything 
I  said  about  him  was  due  to  my  friendship  for  him  and  not  because  of 
his  real  personal  merit,  but  I  am  compelled  to  introduce  him  to  you  as 
one  of  our  men  of  science  who  have  worked  most  in  the  different 
branches  of  medicine,  and  who,  at  the  same  time  has  been  not  only  the 
physician  but  the  friend  of  all  his  patients,  and  who,  on  the  other 
hand,  has  been  one  of  the  pillars  of  all  the  scientific  works  of  the 
society  to  which  he  belongs.  He  is  very  well  known  among  us  and  I 
sincerely  wish  he  should  be  equally  well  known  among  you. 

DR.  MENDIZABAL.  Above  all  allow  me  to  express  my  gratitude  for 
the  kind  and  affectionate  words — which  I  don't  think  I  deserve — of 
my  dear  friend  Dr.  Liceaga,  inspired  by  a  good  and  old  friendship  of 
40  years  of  work  and  which  can  never  be  broken. 

Allow  me  also,  gentlemen,  since  we  have  finished  our  task,  to  con- 
gratulate myself  in  the  name  of  the  Republic  of  Nicaragua,  which  I 
have  the  honor  to  represent  here,  and  to  congratulate  ourselves  for  the 
success  attained  by  this  International  Sanitary  Convention,  inasmuch 
as  the  work  which  has  been  done  will  bear  good  fruit  and  be  beneficial 
to  the  future. 

Allow  me  also  to  thank  the  representatives  of  the  Mexican  Republic, 
its  President  and  people  for.  the  innumerable  courtesies  they  have 
shown  to  all  the  delegates  during  our  short  stay  in  this  country,  and 
allow  me  also  to  congratulate  this  people,  as  has  been  done  before,  for 
their  progress  which  we  knew  only  by  name,  and  which  we  are  now 
practically  acquainted  with  because  we  have  seen  pass  before  our 
eyes  millions  of  dollars  which  the  Mexican  Government  has  spent  in 
carrying  out  one  of  the  most  beneficent  measures — that  concerning 
public  health.  For  this  reason,  the  Mexican  Government  is  entitled  to 
be  further  congratulated. 

Allow  me  also  to  fervently  pray  that  Providence,  who  has  endowed 
Mexico  with  a  splendid  government,  may  prolong  for  many  years  the 
life  of  its  Chief  Executive  and  may  also  prolong  that  of  his  right- 
hand  man  in  sanitary  matters.  Dr.  Liceaga  has  been  wisely  selected 
by  General  Diaz  to  direct  all  the  men  who  will  have  to  help  him  in 
his  grand  work  of  progress  and  peace. 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  IO9 

I  beg  to  congratulate  all  the  delegates  of  the  sister  republics  for  the 
magnificent  work  they  have  brought  to  us  thus  pointing  out  to  us  and 
conveying  an  exact  idea  as  to  the  work  they  have  done  and  are  doing 
in  those  republics,  and  how  they  have  struggled  in  behalf  of  health  and 
the  preservation  of  life. 

We  already  know  this  because  we  have  just  returned  from  a  trip  to 
South  America,  where  we  had  gone  especially  to  call  the  attention  of 
the  Argentine  Republic,  Brazil,  Chile,  Peru,  etc.,  to  the  great  benefits 
to  be  derived  from  perfect  hygiene.  Some  of  these  countries  were  not 
entirely  unknown  to  us,  and  we  have  just  had  occasion  to  see  that  they 
follow  the  same  course,  the  same  methods,  and  that  all  of  them  are 
looking  after  the  health  of  their  fellow  citizens. 

Finally,  gentlemen,  before  we  say  farewell,  for  a  short  time,  since 
we  are  soon  to  meet  again,  if  life  and  health  so  permit,  to  express  the 
desire  that  all  my  colleagues,  upon  returning  to  their  respective  coun- 
tries may  find  their  homes  as  they  left  them — where  we  are  always 
happy — and  that  they  may  reap  the  reward  of  their  efforts.  I  pray 
that  their  countries  may  continue  to  prosper  and  progress,  so  that  they 
may  reach,  without  any  obstacle,  the  goal  of  their  greatness,  which 
they  doubtless  will  attain,  inasmuch  as  the  people  of  the  world  discov- 
ered by  Columbus,  seem  to  live  in  the  land  selected  by  God  for  the 
development  of  all  the  blessings  of  liberty. 

Be  ready,  gentlemen,  to  erect  a  throne  (don't  get  frightened  at  this 
word  which  frightens  many  American  nations),  get  ready  to  erect 
a  throne  to  the  great  goddess  before  whom  we  all  bow,  the  goddess 
before  whom  all  civilized  nations  kneel  down — Hygiene.  All  the  im- 
pulses of  civilization  come  to  us  from  the  Old  World.  Let  us  work 
so  that  America  may  be  the  worthy  throne  of  civilization  sent  to  us 
by  that  Old  World,  and  let  us  retain  it  here  forever,  lest  disheartened, 
it  may  return  again  to  India  from  whence  it  came. 

Gentlemen,  I  wish  you  much  happiness,  and  that  everyone  of  you: 
may  be  entirely  happy  in  your  homes. 

THE  CHAIRMAN.  Dr.  Rodolfo  Gonzalez,  Delegate  of  Salvador,  will 
make  some  remarks.  Dr.  Gonzalez  is  a  countryman  of  ours,  and  has 
established  himself  in  Salvador  where  his  merits  have  been  recognized, 
and  where  he  has  been  given  a  high  place  in  the  army.  He  has  had 
great  experience  in  matters  relating  to  public  health.  I  mention  this 
fact  because  I  am  proud  of  it. 

DR.  GONZALEZ.  Those  who,  like  myself,  knew  Mexico  25  years  ago, 
and  return  to  it  now,  find  that  where  ponds  formerly  stood  are  now 
streets  of  asphalt;  that  at  points  that  were  formerly  foci  of  infection 
hospitals  or  sanitariums  are  now  to  be  found ;  that  all  the  branches  of 
public  health  are  so  well  administered  that  if  Mexico  continues  in  this 
way,  it  will  become,  owing  to  the  untiring  energy  of  Dr.  Liceaga,  a 
place  where  good  health  will  be  epidemic.  (Applause).  All  this, 
gentlemen,  is  due,  undoubtedly,  to  the  wise  administration  of  General 
Diaz,  and  to  the  great  ability  of  Dr.  Liceaga,  who  is  everywhere,  who 
sacrifices  himself,  and  who  employs  in  work  in  behalf  of  mankind  the 
hours  which  we  devote  to  the  family,  to  quietness  and  repose. 

With  patriotic  philanthropy  and  abnegation  he  never  counts  the 
hours  of  work,  nor  does  he  measure  the  hours  of  repose,  because  he 
devotes  all  his  time  for  the  benefit  of  others,  even  at  the  risk  of  sacri- 


IIO  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

ficing  his  own  health  and  interest.  I  fervently  pray  to  God,  with  the 
true  faith  of  a  believer,  to  preserve  the  life  of  men  such  as  he  who 
now  directs  the  destinies  of  the  Mexican  Nation,  and  of  all  his  illus- 
trious co-workers,  including  Dr.  Liceaga,  of  course,  in  the  Depart- 
ment of  Hygiene,  and  which  is  an  honor  to  the  nation  and  a  benefit  to 
mankind. 

In  the  name  of  the  Government  of  Salvador,  I  promise  this  conven- 
tion that  I  shall  fulfill  all  the  promises  I  have  made  here  concerning 
hygiene.  (  Applause. ) 

THE  CHAIRMAN.  Gentlemen:  Uruguay  is  represented  here  by  Dr. 
Ernesto  Fernandez  Espiro.  It  is  only  three  days  since  we  met  him — 
at  least  the  majority  of  us — and  we  have  already  discovered  in  him  a 
man  of  lofty  ideals,  of  deep  learning,  of  much  foresight  concerning 
public  health,  all  of  which  will  not  only  be  beneficial  to  his  country  but 
to  all  the  American  republics. 

DR.  ESPIRO.  Mr.  Chairman  and  delegates:  I  must  first  express  my 
thanks  for  the  kind  and  unmerited  words  just  spoken  by  Dr.  Liceaga, 
as  well  as  for  the  courtesies  shown  me  since  my  arrival  at  this  splendid 
and  beautiful  Capital,  which  progresses  continually,  solving  without 
delay  some  of  the  most  important  and  far  reaching  problems  of  hy- 
giene. 

I  do  not  know  whether  it  will  be  my  good  fortune  to  return  here,  I 
do  not  know  whether  I  shall  have  the  opportunity  of  again  shaking 
the  friendly  hands  that  have  been  extended  to  me  on  this  occasion, 
but  be  that  as  it  may,  I  shall  always  retain  a  pleasant  remembrance 
of  the  happy  and  tranquil  days  that  I  have  spent  under  this  beautiful 
sky  and  in  the  radiant  light  of  the  Mexican  sun — all  those  days  in 
which  I  have  shared  with  you  the  tasks  of  a  common  work,  and  in 
which  we  have  united  all  our  efforts  and  glory  in  the  highest,  the 
noblest,  the  most  civilizing  and  humanitarian  work. 

Friends,  companions,  and  delegates,  with  the  same  affectionate  and 
cordial  words  with  which  I  had  the  honor  to  greet  you  on  my  arrival 
here,  I  now  take  leave  of  you  in  the  hour  of  parting. 

THE  CHAIRMAN.  Delegates:  The  final  part  of  our  program  re- 
quires me  to  say  something  in  answer  to  your  words  of  farewell,  but  I 
can  not  adequately  reply.  I  took  some  notes  during  the  meeting  for 
the  purpose  of  making  a  resume  of,  what  has  been  said,  because  it 
seems  to  me  that  the  Chairman  of  the  Convention  should  do  this,  but 
in  spite  of  this  fact  I  can  not  fulfil  this  part  of  my  duties.  I  tried  to 
do  so,  and  here  is  the  raw  material,  but,  I  repeat,  I  have  not  been  able 
to  make  the  resume,  because  I  have  not  had  time  to  do  so.  I  regret 
very  much  that  the  last  part  of  the  program  can  not  be  carried  out. 

But  if  I  was  not  able  to  do  that  which  it  was  planned  that  I  should 
do,  I  am  going  to  take  the  liberty  of  reminding  you  of  that  which  was 
formerly  done. 

Common  sense,  which  continues  to  be  the  guide  of  humanity  at  the 
present  time,  has  caused  purely  theoretical  conceptions  of  purely 
speculative  ideas  to  pass  into  the  realm  of  the  practical.  In  former 
congresses,  scientific  as  well  as  other  kinds,  the  best  aspirations,  the 
most  perfect  ideals  of  humanity  were  discussed,  but  after  the  meetings 
were  over,  each  delegate  carried  away  the  impressions  of  the  beautiful 
phrases,  of  the  lofty  thoughts,  of  the  superior  intelligence  of  the  ora- 


THIRD    INTERNATIONAL    SANITARY    CONVENTION.  Ill 

tors,  but  with  the  hope  that  that  which  had  been  considered  could  be 
realized  at  some  future  time.  We  also  have  good  orators,  as  you  have 
just  heard,  such  as,  for  example,  Drs.  Espiro,  Azurdia,  Lazo  Arriaga, 
Gonzalez  and  Mendizabal,  and  the  only  difference  between  the  men  of 
that  time  and  those  of  today,  is  that  the  former  thought  properly  but 
did  not  act,  while  the  latter  not  only  thought  but  acted  properly.  This 
is  not  optimism  nor  an  illusion. 

It  is  not  more  than  six  years  since  the  Second  International  Con- 
ference of  American  States  met  here,  and  during  the  last  days  of  its 
sessions — January  29,  1902 — it  approved  a  resolution  on  international 
sanitary  police  in  conformity  with  the  clause  that  I  have  just  read.  It 
was  agreed  that  within  a  year  from  that  date  a  Sanitary  Convention 
composed  of  delegates  from  the  sanitary  bureaus  of  the  American 
republics,  should  meet  in  Washington.  The  promise  was  fulfilled,  the 
resolutions  having  been  adopted  on  January  29,  and  the  first  meeting 
held  on  December  5,  1902.  The  results  of  the  first  meeting  were  very 
important,  because  then,  for  the  first  time  in  a  scientific  congress  of 
an  international  character,  very  important  declarations  were  made  con- 
cerning the  transmission  of  yellow  fever,  which  was  well  known  to 
the  majority  of  physicians,  but  which,  up  to  that  time,  had  received 
no  official  sanction. 

Subsequently  the  first  conference  in  Santiago  de  Chile  could  not  take 
place,  but  the  second  conference  was  held  in  Washington  from  the  9th 
to  the  1 4th  of  October,  1905,  in  which  great  activity  was  shown, 
resulting  in  the  preparation  of  an  international  treaty — because  the 
Sanitary  Convention  (Treaty)  of  Washington,  although  identical  with 
that  of  Paris,  nevertheless,  had  to  add  the  part  concerning  yellow 
fever,  which  was  only  announced  in  the  Convention  of  Paris.  I  re- 
peat, six  days  were  only  necessary  in  which  to  celebrate  an  interna- 
tional treaty !  This  work  seems  to  me  to  be  of  great  importance,  as 
were  the  other  resolutions  which  were  adopted.  The  motion  made  by 
Dr.  Wyman  concerning  the  collection  in  a  single  book  of  all  the  reso- 
lutions adopted  at  the  previous  conventions,  means  that  in  future  we 
shall  have  a  Code  which  covers  the  better  and  larger  part  of  the  knowl- 
edge that  has  been  acquired  on  public  hygiene. 

The  Third  International  Sanitary  Convention  was  held  in  turn  and 
in  due  time.  It  is  flattering  for  me  to  say  that  the  part  concerning 
hygiene,  and  that  contained  in  resolutions  adopted  by  the  Pan-Ameri- 
can Conference  have  been  successfully  carried  out. 

The  work  we  have  now  done  can  not  be  properly  understood  for 
some  time  to  come,  but  matters  which  most  interested  all  of  us  were 
treated,  and  have  been  put  into  effect  with  great  precision. 

An  interesting  fact  is  that  all  the  delegates  who  have  come  here  were 
prepared  by  their  scientific  knowledge  to  inform  us  of  the  results  of 
their  experience.  There  have  been  resolutions  such  as  those  relating 
to  tuberculosis,  that  when  they  were  given  to  Dr.  Soza  he  had  only  to 
formulate  them  because  they  had  already  been  well  studied.  This 
proves  that  the  work  is  bearing  fruit,  and  that  it  is  easy  to  do  when 
there  is  a  will  to  do  it.  For  these  reasons  it  can  be  deduced  in  an 
entirely  practical  manner,  that  the  union  of  the  American  nations  is 
being  effected. 


112  THIRD    INTERNATIONAL    SANITARY    CONVENTION. 

This  lack  of  discrepancy  in  all  the  matters  that  we  have  treated,  this 
simplicity  in  the  manner  of  discussing  them,  removing  from  them  every 
aspect  of  ostentation  and  vanity,  this  persistence  in  arriving  at  cor- 
rect and  practical  conclusions  is  the  most  important  proof  of  the 
benefits  that  meetings  of  this  class  bring,  not  only  to  the  peoples  of 
America  but  to  all  mankind. 

I  congratulate  myself  that  Mexico  should  have  been  selected  for  the 
holding  of  this  Convention,  and  that  her  invitation  has  been  accepted 
by  13  American  Republics;  I  congratulate  myself  in  my  name  and  in 
that  of  my  Government,  for  the  courtesies  that  we  have  received  from 
you,  and  I  have  no  words  with  which  to  sufficiently  express  my 
gratitude. 

Gentlemen,  let  this  proof  of  confraternity  which  is  presented  to  the 
Third  International  Sanitary  Convention  of  the  American  Republics, 
be  a  pledge  that  in  future  these  meetings  shall  be  more  numerous,  and 
that  they  will  be  attended  not  by  a  certain  number  of  republics,  but  by 
all  of  the  republics  of  the  Western  Hemisphere. 

I  wish  that  in  those  pleasant  impressions  which  you  say  you  will 
carry  away  with  you,  and  which  is  so  gratifying  to  me,  you  will  see 
the  sincerity  of  the  intentions  that  inspires  the  Mexican  delegation. 
(Applause.) 

Among  the  resolutions  proposed  by  the  Secretary  of  the  Conven- 
tion is  one  referring  to  the  appointing  of  a  committee  to  convey  to- 
the  President  of  the  Republic  the  thanks  of  the  Convention  for  his 
courtesies  to  it  and  for  the  valuable  assistance  rendered  it.  The  com- 
mittee is  composed  of  Drs.  Fernandez  Espiro,  Wyman,  Lazo  Arriaga> 
Ferrer,  and  Gutierrez  Lee.  Gentlemen,  farewell. 

The  session  adjourned. 


APPENDIX 


THIRD  INTERNATIONAL  SANITARY  CONVENTION. 


FEASTS  AND  SOCIAL  FUNCTIONS  IN  HONOR  OF  THE 

DELEGATES. 

The  courtesy  and  splendor  with  which  the  foreign  delegates  were  received  in 
Mexico  by  the  National  and  Federal  District  Governments,  by  the  Supreme  Board 
of  Health,  and  by  the  Mexican  Delegation  to  the  Conference,  were  indeed 
most  notable. 

In  the  afternoon  of  the  3rd  of  December  we  were  cordially  received  in  the 
National  Palace  by  His  Excellency  General  Porfirio  Diaz,  the  President  of  the 
Republic.  In  the  night  of  the  4th  we  were  tendered  an  informal  reception  at 
the  Department  of  Foreign  Relations,  at  which  occasion,  on  account  of  the 
illness  of  Seiior  Don  Ignacio  Mariscal,  the  Department  was  represented  by 
Senor  Don  Jose  Algara,  whose  unexpected  death  we  now  mourn  profoundly. 
After  a  delicious  tea  the  delegates  were  presented  with  an  artistic  gold  medal, 
representing  the  Pan-American  Union  and  bearing  the  following  inscription : 
"Third  International  Sanitary  Convention,  Mexico,  December  2  to  7,  1907."  At 
the  same  time  Dr.  Eduardo  Liceaga  presented  each  delegate  with  a  gold  Aztec 
calendar,  with  the  Mexican  colors  in  the  pin  from  which  it  hung. 

On  the  night  of  the  2nd  a  magnificent  banquet  was  given  us  in  the  Municipal 
Palace  by  the  Government  of  the  Federal  District  and  the  Supreme  Board  of 
the  Municipality  of  the  Capital.  The  abundance  of  flowers  and  lights  with  which 
the  Municipal  Palace  was  ornamented  offered  a  most  wonderful  view.  The 
banquet  was  presided  over  by  Don  Guillermo  de  Landa  y  Escandon,  Governor  of 
the  Federal  District,  who  delivered  an  eloqueut  speech  to  which  Dr.  Pedro  L. 
Ferrer,  of  Chile,  replied  in  the  name  of  the  foreign  delegates. 

In  the  morning  of  the  3rd  we  made  a  visit  to  the  Penitentiary  of  the  Federal 
District,  where  we  were  cordially  received  by  the  Director  of  the  institution, 
Don  Octaviano  Liceaga.  The  conditions  of  safety,  hygiene,  comfort  and  disci- 
pline prevailing  in  the  Penitentiary  were  justly  praised  by  the  delegates. 

In  the  afternoon  of  the  3rd  we  were  tendered  an  automobile  ride  to  the  Castle 
of  Chapultepec,  where  we  had  occasion  to  admire  the  exquisite  taste  displayed 
in  the  furniture  and  ornaments  of  the  different  apartments.  After  visiting  this 
sumptuous  edifice  and  taking  a  ride  through  the  beautiful  park  that  surrounds 
it,  we  stopped  at  the  Cafe  de  Chapultepec,  where  a  tea  was  tendered  us,  beauti- 
ful ladies  of  the  society  of  Mexico  honoring  us  with  their  company. 

In  the  afternoon  of  the  4th  we  visited  the  magnificent  new  Post-Office  build- 
ing, which  adds  to  its  beautiful  architecture  all  the  necessary  elements  for  the 
good  administration  of  so  important  a  branch  of  the  Government.  Engineer 
Don  Norberto  Dominguez,  Director-General  of  Posts,  received  us  most  ^courte- 
ously  and  presented  us  with  a  luxuriously  printed  pamphlet  describing  the  new 
building. 

After  the  sessions  of  the  4th  we  visited  the  offices  and  dependencies  of  the 
Supreme  Board  of  Health;  we  had  occasion  to  see  the  complete  equipment  of 
stoves,  pumps,  disinfecting,  apparatus  and  other  instruments  used  in  the  splendid 
sanitary  service  of  the  Federal  District.  Taking  into  consideration  the  recog- 
nized ability  of  Doctor  Liceaga  in  sanitary  matters,  his  progressive  ideas,  his 
indefatigable  activity,  the  fitness  of -his  subordinate  employees,  and  the  well- 
merited  trust  that  the  Government  of  President  Diaz  has  placed  upon  him,  one 
can  easily  explain  the  great  progress  achieved  in  Mexico  during  the  last  years 
in  all  that  tends  to  the  improvement  of  Public  Health. 

In  the  night  of  the  4th  a  concert  in  the  Arbeu  Theatre  was  given  in  honor  of 
the  Delegates.  The  theatre  was  beautifully  decorated,  and  the  attendance  was 
large  and  select;  the  musical  program  was  wonderfully  executed  by  the  artists 
that  participated  in  the  concert. 

The  5th  was  spent  in  an  excursion  to  Xochimilco,  where  we  had  opportunity 
to  admire  the  great  Water  Works,  nearing  completion,  that  will  supply  the  city 
with  pure  water.  We  were  received  by  Engineer  Marroquin  Rivera,  Director  of 


Il6  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

the  Works,  thanks  to  whom  we  were  able  to  appreciate  that  remarkable  plant. 
From  Chapultepec  we  were  taken  in  an  express  train  to  Xochimilco.  At  I 
o'clock  in  the  afternoon  a  splendid  banquet  was  served  in  the  open  air  and 
under  an  arch  made  of  tree  branches,  palms  and  flowers.  This  banquet  was 
rendered  most  charming  by  the  presence  of  the  beautiful  ladies  that  attended 
it  and  by  the  melodies  played  by  an  excellent  orchestra.  Dr.  Liceaga  presided 
over  the  banquet  and  delivered  a  speech  with  the  eloquence  that  characterizes 
him,  and,  at  the  request  of  the  delegates,  Dr.  Azurdia,  of  Guatemala,  thanked 
Dr.  Liceaga  in  their  name.  At  half-past  two  we  sailed  around  the  lake  in 
big  canoes  that  were  richly  decorated,  and  thus  was  ended  one  of  the  most 
pleasant  excursions. 

In  the  afternoon  of  the  6th  we  took  an  automobile  drive  to  the  Juarez, 
Roma,  and  La  Condesa  colonies,  as  the  new  suburbs  are  called.  In  the  same 
afternoon  we  visited  the  General  Hospital  of  Mexico,  a  large  and  elegantly  built 
institution  which  fills  all  the  modern  requirements.  Its  system  of  pavilions,  the 
extent  of  its  site,  its  good  ventilation,  perfect  hygienic  conditions,  and  magnifi- 
cent administration  place  it  among  the  first  in  the  world. 

Afterwards  we  went  to  inspect  the  Pumping  Station  and  Sewer-cleaning 
plant,  magnificent  institutions  which  are  classed  among  the  best  of  the  sanitary 
works  of  Mexico. 

On  the  7th,  at  8  o'clock  in  the  evening,  we  were  tendered  a  splendid  farewell 
banquet  by  the  Mexican  Delegation,  which  took  place  in  the  "Salones  Sylvain." 
This  banquet  was  attended  by  the  Assistant  Secretary  of  Foreign  Relations,  rep- 
resenting the  Secretary  who  was  ill  at  that  time,  the  United  States  Ambassa- 
dor, the  Minister  Plenipotentiaries  of  Spain,  Italy  and  Belgium,  the  Charges 
d' Affaires  Guatemala  and  Salvador,  several  foreign  consuls,  all  the  Delegates 
to  the  Convention,  and  several  representative  gentlemen.  Dr.  Liceaga  offered 
the  banquet  with  a  well-worded  toast  which  he  closed  saying:  "I  drink,  gentle- 
men, to  the  personal  prosperity  and  to  the  health  of  your  chiefs  executive,  to 
the  prosperity  of  the  nations  represented  in  this  congress,  and  that  the  inhabi- 
tants of  the  whole  universe  may  consider  themselves  as  one  single  nation  in  all 
that  relates  to  the  preservation  of  human  health,  or  to  the  achievement  of  uni- 
versal peace."  Dr.  E.  Fernandez  Espiro,  of  Uruguay,  responded  to  the  toast 
of  Dr.  Liceaga,  in  the  name  of  all  the.  delegates,  and  closed  his  remarks  drinking 
to  the  health  of  the  President  of  the  Mexican  Republic  and  Doctor  Liceaga. 
Then,  Sefior  Licenciado  Jose  Algara,  Assistant  Secretary  of  Foreign  Relations, 
spoke  in  the  name  of  the  Mexican  Government,  and  praised  the  progress  of 
modern  hygiene,  the  scientists  that  were  honoring  Mexico  with  their  presence, 
and  Dr.  Liceaga. 

My  colleagues  of  the  Convention  honored  me  with  the  pleasure  of  answering 
to  the  official  toast  of  the  Assistant  Secretary  of  Foreign  Relations.  After^con- 
gratulating  the  Mexican  Government  for  the  progress  achieved  in  the  country 
thanks  to  its  well-directed  efforts,  and  the  activity  it  had  displayed  in  the  work 
that  now  speaks  so  highly  in  its  favor,  and  after  making  special  mention  of  the 
remarkable  impulse  which  had  been  given  to  sanitary  works,  in  the  ports  as  well 
as  in  important  cities,  principally  the  capital,  I  closed  my  remarks  drinking  to 
the  health  of  President  General  Porfirio  Diaz  and  his  officials,  who  fully  realized 
the  importance  of  the  improvement  of  public  health ;  to  the  welfare  of  the  noble 
nation  that  had  received  us  so  splendidly;  to  the  health  of  the  Mexican  Delega- 
tion, whose  attentions  to  us  had  no  bounds;  and  to  the  health  of  the  illustrious 
Mexican,  the  eminent  Doctor  Liceaga,  our  chief,  teacher  and  friend. 

Upon  the  closing  of  my  remarks,  I  had  the  pleasure  of  fulfilling  the  mission 
with  which  my  colleagues  had  entrusted  me,  placing  in  the  hands  of  Dr.  Liceaga 
a  copy  in  parchment,  signed  by  all  the  Delegates  to  the  Convention,  of  the  reso- 
lution in  which  is  stated  the  appreciation  and  recognition  that  we  all  felt  towards 
him  for  the  most  valuable  services  he  has  rendered  his  country,  and  in  which  a 
tribute  of  respect  and  admiration  is  paid  to  the  distinguished  hygienist  of  Mexico, 
glory  of  the  medical  profession  of  the  American  Continent. 

Finally,  it  is  mv  pleasant  duty  to  express  in  the  name  of  all  the  delegates  our 
sincere  appreciation  for  the  many  attentions  that  were  accorded  to  us  in  Mexico, 
and  to  the  persons  who  honored  us  with  social  functions,  making  special  mention 
of  Doctors  Liceaga  and  Monjarras  and  their  families. 

New  York,  November,  1908.  (Signed)  JUAN  J.  ULLOA. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION  OF 
AMERICAN  REPUBLICS. 

MEXICO,  December  6,  1907. 
MR.  PRESIDENT: 

We  have  the  honor  to  inform  you  that  at  the  session  held  yesterday  by  the 
Third  International  Sanitary  Convention  of  American  Republics  the  Honorable 
Delegate  from  Uruguay,  Doctor  Fernandez  Espiro,  made  the  following  remarks : 

I  have  listened  with  great  pleasure  to  the  report  that  has  just  now  been 
read  by  the  President  of  the  Convention,  regarding  the  works  of  sanita- 
tion that  have  been  carried  out  in  the  Mexican  Republic,  and,  if  all  the 
delegates  here  present  agree  with  the  motion,  I  would  propose,  in  their 
name  and  in  my  own,  that  a  resolution  be  adopted  expressing  the  gratify- 
ing impression  that  the  reading  of  that  report  has  afforded  us,  and  that 
a  copy  of  the  said  resolution  be  forwarded  to  the  Government  of  Mexico, 
through  Honorable  Doctor  Liceaga,  President  of  the  Convention. 

The  motion  having  been  seconded  by  the  Delegate  from  Costa  Rica,  and  ac- 
cepted by  all  the  delegates,  it  was  submitted  to  the  Convention  and  unanimously 
aoproved. 

The  Chairman  of  the  Convention  expresses  his  appreciation  therefor,  and 
stated  that  he  would  be  pleased  to  transmit  the  resolution  to  the  President  of 
the  Republic. 

We  take  advantage  of  the  opportunity  to  renew  the  assurances  of  our  most 
distinguished  consideration. 

(Signed)    E.  LICEAGA, 

Chairman  of  the  Convention. 
(Signed)    JUAN  J.  ULLOA, 

Secretary  of  the  Convention. 
To  SENOR  GENERAL  DON  PORFIRIO  DIAZ, 

President  of  the  United  Mexican  States, 
Present. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION  OF 
AMERICAN  REPUBLICS. 

In  the  City  of  Mexico,  the  seventh  day  of  December,  1907,  the  Delegates  to 
the  Third  International  Sanitary  Convention  of  American  Republics  assembled 
in  the  National  Palace,  expressed  the  feelings  of  esteem  and  admiration  that  they 
have  for  Doctor  Eduardo  Liceaga,  Chairman  of  the  Convention,  by  reason  of 
the  valuable  services  that  he  had  rendered  to  Public  Health  in  his  country,  and 
resolved,  by  acclamation,  to  pay  a  tribute  of  respect  and  admiration  to  the  dis- 
tinguished hygienist  of  Mexico,  glory  of  the  medical  profession  in  the  American 
Continent. 

Signed  by  all  the  Delegates  to  the  Convention. 


THIRD  INTERNATIONAL  SANITARY   CONVENTION  OF 
AMERICAN  REPUBLICS. 

The  Delegates  from  Brazil,  Colombia,  and  Uruguay,  to  the  Third  International 
Sanitary  Convention  of  American  Republics,  duly  authorized  by  their  Govern- 
ments, in  the  official  capacity  with  which  they  are  invested,  state  that:  Deeming 
it  useful  and  convenient  to  adopt  for  their  respective  countries  the  Convention 
signed  at  Washington  the  I4th  of  December,  1905,  and  in  accordance  with  the 
Transitory  Article  thereof,  they  accept  and  sign  ad  referendum,  in  the  name  of 
their  respective  Governments,  the  said  Convention  signed  at  Washington  the 
I4th  of  December,  1905. 

Signed  in  quadruplicate,  two  copies  in  Spanish  and  two  in  English,  in  the  Hall 
of  Sessions  of  the  Department  of  the  Treasury,  National  Palace  of  Mexico,  on 
the  7th  of  December,  1907. 

OSWALDO  GONCALVEZ  CRUZ, 

Delegate  from  Brazil. 
GENARO  PAYAN, 
RICARDO  GUTIERREZ, 

Delegates  from  Colombia. 
E.  FERNANDEZ  ESPIRO, 

Delegate  from  Uruguay. 


SUBJECTS  THAT  WILL  FORM  PART  OF  THE  PROGRAM 
FOR  THE  FOURTH  INTERNATIONAL  SANITARY 
CONVENTION  THAT  WILL  BE  HELD  IN  SAN  JOSE, 
COSTA  RICA,  IN  DECEMBER,  1909. 

In  order  to  give  publicity,  for  the  information  in  advance  of  the  different 
countries  of  America,  to  some  of  the  important  subjects  that  will  be  discussed 
in  the  next  sanitary  Convention,  I  take  the  liberty  to  publish  herewith  the  reso- 
lution adopted  by  the  International  Sanitary  Bureau  of  Washington  in  its  session 
of  October  4,  1908. 

Among  other  subjects,  the  program  for  the  Fourth  International  Sanitary 
Convention  of  American  Republics  shall  include  the  following: 

ist.  Each  delegate  will  present  a  report  regarding  the  manner  in  which  the 
resolutions  adopted  in  the  three  previous  Conventions  have  been  put  into 
practice  in  their  respective  countries. 

2nd.  Reports  in  regard  to  sanitary  conditions  in  ports  and  measures  pro- 
posed for  the  improvement  of  such  sanitary  conditions  (with  special  refer- 
ence to  the  principal  ports). 

3rd.  Reports  relating  to  the  registration  of  the  movement  of  population 
and  the  mortality  of  each  country. 

4th.  Sanitation  of  cities  and  specially  of  ports. 

5th.  Measures  for  the  protection  of  passengers  that  embark  in  vessels 
leaving  Infected  ports. 

(Signed)    JUAN  J.  ULLOA, 
Permanent  Secretary. 


RESOLUTIONS  ADOPTED  BY  THE  FIRST,  SECOND,  AND 
THIRD  INTERNATIONAL  SANITARY  CONVENTIONS. 

The  following  resolutions,  adopted  by  the  First,  Second,  and  Third  Interna- 
tional Conventions  of  the  American  Republics,  are  hereby  published,  in  accord- 
ance with  the  direction  of  the  last  named  Convention,  held  in  the  City  of  Mexico, 
from  December  2  to  December  7,  1907: 

RESOLUTIONS  ADOPTED  BY  THE  FIRST  INTERNATIONAL  SANI- 
TARY CONVENTION  OF  AMERICAN  REPUBLICS,  HELD  IN  THE 
CITY  OF  WASHINGTON,  DECEMBER  2,  3,  AND  4,  1902. 

REPORT  OF  COMMITTEE  ON  ORGANIZATION. 

Your  committee  respectfully  report  that  to  carry  out  the  intent  of  this  sanitary 
convention  there  should  be — 

1.  A  president,  who  shall  also  be  the  chairman  of  the  executive  board  known 
as  the  International  Sanitary  Bureau. 

2.  One  vice-president  from  each  Republic  represented.    The  duties  of  the  vice- 
presidents  shall  be,  in  the  order  named,  to  preside  in  the  absence  of  the  president. 

3.  A  secretary.    The  duties  of  the  secretary  shall  be  to  keep  a  record  of  the 
proceedings  of  the  convention  from  day  to  day,  with  a  view  to  their  publication 
to  be  followed  by  the  publication  of  specially  prepared  papers  relating  to  the 
designated  subjects. 

4.  An  advisory  council,  to  consist  of  six  delegates.     The  president  shall  be 
ex  officio  a  member  of  said  advisory  council.    The  duties  of  the  advisory  council 
shall  be  to  prepare  the  programme  from  day  to  day,  to  examine  and  pass  upon 
the  papers  which  it  is  proposed  to  be  presented  before  the  convention,  to  con- 
sider resolutions  that  are  presented  in  general  meetings  and  report  upon  them  to 
the  general  body  with  recommendation  either  for  their  passage  or  rejection,  and 
to  attend  to  such  other  matters  as  may  be  referred  to  it. 

The  committee  nominates  the  following  officers  to  fill  the  positions  named: 
For  president:  Surg.  Gen.  Walter  Wyman,  United  States  Public  Health  and 
Marine-Hospital  Service. 

For  vice-presidents:  Senor  Don  Eduardo  Moore,  M.  D.,  Chile;  Seiior  Don 
Juan  J.  Ulloa,  M.  D.,  Costa  Rica ;  Senor  Don  Juan  Guiteras,  M.  D.,  Cuba ;  Senor 
Don  Luis  Felipe  Carbo,  Ecuador;  Senor  Don  Antonio  Lazo-Arriaga,  Guate- 
mala ;  Senor  Don  Nicanor  Bolet  Peraza,  Honduras ;  Senor  Don  Eduardo  Liceaga, 
M.  D.,  Mexico;  Senor  Don  D.  Roman,  M.  D.,  Nicaragua;  Mr.  John  Stewart, 
Paraguay;  Dr.  H.  L.  E.  Johnson,  United  States;  Senor  Don  Luis  Alberto  de 
Herrera,  Uruguay. 

For  secretary:  Dr.  Arthur  R.  Reynolds,  United  States. 

For  members  of  the  advisory  council:  Dr.  Rhett  Goode,  United  States; 
Dr.  M.  J.  Rosenau,  Unfted  States ;  Senor  Don  Juan  Guiteras,  M.  D.,  Cuba ;  Senor 
Don  Eduardo  Liceaga,  M.  D.,  Mexico;  Maj.  Walter,  D.  McCaw,  U.  S.  Army; 
Senor  Don  Juan  J.  Ulloa,  M.  D.,  Costa  Rica. 

Your  committee  further  recommend  that  the  International  Sanitary  Bureau 
shall  consist  of  five  members,  one  of  whom  shall  be  the  president  of  this  Con- 
ference, the  other  four  members  to  be  nominated  to  the  conference  by  the 
advisory  council,  and  the  said  council  shall  also  recommend  to  the  convention 
the  time  and  place  for  the  next  annual  conference. 
Respectfully  submitted. 

Dr.  CARLOS  FINLAY,  of  Cuba, 

Dr.  EDUARDO  MOORE,  of  Chile, 

Dr.  H.  L.  E.  JOHNSON,  of  the  United  States, 

Dr.  GLENDOWER  OWEN,  of  the  United  States, 

Minister  FELIPE  CARBO,  of  Ecuador, 

Committee. 


122  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

I. 

Resolved,  That  the  convention  shall  be  governed  by  the  resolutions  agreed 
upon  by  the  International  Conference  of  American  States  held  in  Mexico  in 
1901  and  1902. 

II. 

Resolved,  That  the  time  of  detention  and  disinfection  at  maritime  quarantine 
stations  shall  be  the  least  practicable  time  consistent  with  public  safety  and  in 
accord  with  scientific  precepts. 

III. 

(a)  Resolved,  That  measures  of  prophylaxis  against  yellow  fever  shall  be  based 
upon  the  fact  that  up  to  the  present  time  the  bite  of  certain  mosquitoes  is  the 
only  proven  natural  means  of  propagation  of  yellow  fever. 

(&)  Resolved,  That  the  Governments  represented  in  this  conference  approve 
the  measures  employed  in  Habana  for  the  prevention  of  the  spread  of  the  disease 
on  land,  for  the  isolation  of  cases  and  the  fumigation  of  buildings,  it  being 
understood  that  said  measures  are  based  upon  the  principle  enunciated  in 
resolution  (a). 

(c)  Resolved,  That  the  prevention  of  the  importation  of  the  disease  by  ves- 
sels wherein  persons  actually  infected  are  found  must  conform  to  the  methods 
employed  on  land,  yet  there  are  questions  concerning  the  importation  of  infected 
mosquitoes  that  require  further  study  before  any  decided  modification  of  the 
quarantine  laws  can  be  recommended. 

(rf)  Resolved,  That  the  subject  of  bringing  the  quarantine  laws  to  conform 
with  the  new  doctrine  of  mosquito  infection  shall  be  referred  to  the  International 
Sanitary  Bureau  of  the  American  Republics  for  report  at  the  next  meeting. 

(e)  Resolved,  That  an  International  Sanitary  Committee  at  Washington  shall 
be  appointed,  and  constituted  as  follows:  Surg.  Gen.  Walter  Wyman,  chairman; 
Dr.  Eduardo  Liceaga,  of  Mexico;  Dr.  Eduardo  Moore,  of  Chile;  Dr.  Juan 
Guiteras,  of  Cuba;  Dr.  Juan  J.  Ulloa,  of  Costa  Rica;  Dr.  Rhett  Goode,  of  the 
United  States ;  Dr.  A.  H.  Doty,  of  the  United  States. 

IV. 

Resolved,  That  the  different  Governments  study,  in  their  respective  territories, 
the  geographical  distribution  of  the  mosquito  of  the  genus  stegomyia,  in  order 
that  said  study  may  have  practical  application  in  subsequent  conventions. 

V. 

Whereas  bubonic  plague  and  other  diseases  are  spread  by  rats,  mice,  and 
other  lower  animals,  which,  to  a  great  extent,  find  sustenance  in  animal  and 
vegetable  kitchen  wastes  commonly  called  garbage :  Therefore,  be  it 

Resolved,  That  all  organic  waste  or  garbage  shall  be  kept  separately  on  the 
premises  until  it  can  be  removed,  unmixed  with  anything  else,  and  destroyed. 

VI. 

Whereas  typhoid  fever  and  Asiatic  cholera  are  caused  by  swallowing  food  or 
drink  contaminated  by  the  discharges  of  previous  cases:  Therefore,  be  it 

Resolved,  That  it  be  recognized  by  this  conference  that  if  all  the  discharges 
of  every  existing  case  of  typhoid  fever  and  Asiatic  cholera  were  instantly 
disinfected,  typhoid  fever  and  Asiatic  cholera  would  cease  to  be  a  menace  to 
the  world. 

VII. 

Whereas  the  Second  American  International  Conference  of  the  Pan-American 
States,  held  in  the  City  of  Mexico,  October,  1001,  to  January,  1902,  provided 
that  a  sanitary  convention  convene  in  Washington  within  one  year  from  the 
signing  of  the  resolutions  on  sanitation  and  quarantine,  and  shall  elect  an  Inter- 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  123 

national  Sanitary  Bureau,  with  permanent  headquarters  at  Washington,  for 
the  purpose  of  rendering  effective  service  to  the  different  Republics  represented 
in  this  convention :  It  is  hereby 

Resolved : 

(a)  That  it  shall  be  the  duty  of  the  International  Sanitary  Bureau  to  urge 
each  Republic  to  promptly  and  regularly  transmit  to  said  bureau  all  data  of 
every  character  relative  to  the  sanitary  conditions  of  their  respective  ports 
and  territories. 

(6)  And  to  furnish  said  bureau  every  opportunity  and  aid  for  a  thorough, 
careful,  and  scientific  study  and  investigation  of  any  outbreaks  of  pestilential 
diseases  which  may  occur  within  the  territory  of  any  of  the  said  Republics. 

(c)  //  is  further  resolved,  That  it  shall  be  the   duty  of  the   International 
Sanitary  Bureau  to  lend  its  best  aid  and  experience  toward  the  widest  possible 
protection  of  the  public  health  of  each  of  the  said  Republics  in  order  that  disease 
may  be  eliminated  and  that  commerce  between  said  Republics  may  be  facilitated. 

(d)  It  is  further  resolved  by  this  convention,  That  it  shall  be  the  duty  of  the 
International  Sanitary  Bureau  to  encourage  and  aid  or  enforce  in  all  proper 
ways  the  sanitation  of  seaports,  including  the  sanitary  improvements  of  harbors, 
sewage,  drainage  of  the  soil,  paving,  elimination  of  infection  from  buildings,  and 
the  destruction  of  mosquitoes  and  other  vermin. 

(e)  It  is  also  recommended  by  this  convention,  That  in  order  to  carry  out  the 
above  measures  a  fund  of  $5,000  shall  be  collected  by  the  Bureau  of  American 
Republics  in  accordance  with  paragraph  7  of  the  resolutions  of  the   Second 
International  American  Conference  above  referred  to. 

VIII. 

Resolved,  That  a  vote  of  thanks  be  extended  by  this  Convention,  for  their 
cordial  hospitality  and  valued  assistance,  to  His  Excellency  Theodore  Roosevelt, 
President  of  the  United  States;  to  His  Excellency  John  Hay,  Secretary  of 
State;  to  His  Excellency  Leslie  M.  Shaw,  Secretary  of  the  Treasury;  to  His 
Excellency  W.  H.  Moody,  Secretary  of  the  Navy;  to  His  Excellency  David  J. 
Hill,  Assistant  Secretary  of  State;  to  His  Excellency  Sefior  Don  Manuel  de 
Aspiroz,  of  Mexico;  to  His  Excellency  Sefior  Don  Gonzalo  de  Quesada,  of 
Cuba;  to  the  ladies  who  honored  and  favored  this  Convention  with  their  pres- 
ence at  the  reception ;  to  the  officers  and  members  of  the  Metropolitan  and  Cos- 
mos Clubs;  and  last,  but  not  least,  to  our  distinguished  president,  Dr.  Walter 
Wyman,  Surgeon-General  of  the  Public  Health  and  Marine-Hospital  Service. 


RESOLUTIONS  ADOPTED  BY  THE  SECOND  INTERNATIONAL  SANI- 
TARY CONVENTION  OF  AMERICAN  REPUBLICS,  HELD  IN  THE 
CITY  OF  WASHINGTON,  OCTOBER  9-14,  1905. 

(Besides  these  resolutions,  a  Convention  ad  referendum  was  signed,  in  regard 
to  preventive  measures  against  cholera,  bubonic  plague  and  yellow  fever.) 

RECOMMENDATIONS   BY  THE   ADVISORY  COUNCIL. 

The  council  recommends  that  the  vice-presidents  of  the  last  Convention  be 
continued  in  office,  excepting  when  the  representation  to  this  Convention  is 
different,  in  which  case  the  new  delegates  are  to  take  the  place  of  the  previous 
ones. 

In  the  case  of  the  Republics  which  were  represented  at  the  last  Convention 
and  which  are  not  represented  at  the  present  Convention  no  vice-presidents  shall 
be  appointed ;  and  the  council  recommends  that  the  respective  delegates  from 
the  countries  which  are  represented  at  this  Convention  for  the  first  time  shall  be 
appointed  as  vice-presidents  also. 

2.  That  the  International  Sanitary  Bureau  as  constituted  at  the  last  meeting 
be  continued. 

3.  That  the  resolutions  presented  by  Dr.  Guiteras  concerning  the  printing  of 
the    5,000   copies    of   the    United    States    Pharmacopoeia   be    recommended    for 
approval. 


124  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

1. 

(a)  Resolved,  That  the  name  of  Surgeon-^General  Wyman  be  presented  to  the 
convention  as  president  for  this  meeting,  and  that  the  name  of  Dr.  Eduardo 
Liceaga  be  presented  to  the  convention  as  president  of  the  next  convention,  and 
that  Dr.  Juan  J.  Ulloa  be  nominated  as  permanent  secretary. 

(d)     Resolved,  That  the  convention  be  held  every  two  years. 

(c)  Resolved,  That  the  next  meeting  be  held  in  the  City  of  Mexico  in  Decem- 
ber, 1907,  subject  to  the  call  of  the  International  Sanitary  Bureau. 

(</)  Resolved,  That  immediately  upon  the  completion  of  the  organization  the 
president  recognize  Dr.  Eduardo  Liceaga  for  a  statement  of  general  interest. 

(?)  Resolved,  That  the  committee  suggest  that  reports  of  the  Republics  of 
great  length  should  be  abstracted  for  presentation  to  the  convention.  The  full 
papers  will  be  published  in  the  transactions. 

II. 

Whereas  the  decennial  edition  of  the  United  States  Pharmacopoeia  has  just 
been  published  and  issued  by  the  board  of  trustees  of  the  convention  of  the 
United  States  Pharmacopoeia  appointed  by  the  American  Pharmaceutical  Asso- 
ciation, and 

Whereas  this  revised  pharmacopoeia  embraces  many  new  forms  of  value,  both 
for  use  in  therapeusis  and  prevention  of  epidemic  disease  and  represents  the 
best  thought  and  labor  of  experts  on  these  matters :  Therefore  be  it 

(a)  Resolved,  That  a  translation  of  this  United  States  Pharmacopoeia  into  the 
Spanish  language  would  prove  of  great  benefit  to  the  medical  profession  and 
pharmacists  in  each  of  the  republics  represented  in  this  convention ;  and  further, 

(&)  Resolved,  That  the  said  pharmacopoeia  be  referred  to  the  several  govern- 
ments to  report  upon  at  the  next  meeting  in  Mexico,  with  a  view  to  the  adoption 
of  an  international  pharmacopoeia  for  the  American  republics ;  and  be  it  further 

(c)  Resolved,  That  the  International  Sanitary  Bureau  be  requested  to  ascertain 
if  it  is  possible  for  the  payment  for  such  translation  and  publication  of  an  edition 
of  5,000  copies  to  be  made  out  of  the  fund  provided  for  in  section  7  of  the 
resolutions  adopted  by  the  Second  International  Conference  of  American  States, 
held  in  the  City  of  Mexico  in  the  winter  of  1901-2;  and  be  it  further 

(d)  Resolved,  That  if  it  is  found  that  the  expense  of  this  translation  and  publi- 
cation can  not  be  provided  for  from  the  fund  provided  by  said  section  7,  the  mat- 
ter to  be  referred  to  the  Bureau  of  the  American  Republics,  with  the  request  that 
if  possible  the  said  translation  and  publication  be  provided  for  by  the  said  Bureau. 

III. 

Whereas  the  Republic  of  Mexico  and  the  Panama  Canal  Zone,  by  the  applica- 
tion of  the  mosquito  doctrine  to  public  sanitation,  are  nearing  rapidly  the 
desideratum  of  the  final  extinction  of  yellow  fever;  and 

Whereas  the  Republic  of  Cuba,  by  the  application  of  the  same  methods,  has 
continued  to  maintain  its  territory  free  from  yellow  fever;  and 

Whereas  as  through  lack  of  preparation  to  apply  these  methods  the  spread  of 
yellow  fever  has  been  permitted  in  certain  countries ;  and 

Whereas  in  the  city  of  New  Orleans  an  epidemic  unfortunately  took  a  firm 
foothold  has  been  held  in  check,  and  has  been  gradually  reduced  by  the  applica- 
tion of  the  said  methods  in  the  midst  of  the  largest  nonimmune  population  that 
was  ever  exposed  to  yellow  fever :  Therefore  be  it 

(a)  Resolved,  That  this  convention  sees  in  these  results  a  further  confirmation 
of  the  view  that  yellow  fever  is  naturally  transmitted  only  by  the  bite  of  infected 
mosquitoes. 

(b) That  the  convention  is  of  opinion  that  an  efficient  plan  of  defense  against 
the  propagation  of  yellow  fever  at  the  beginning  of  an  epidemic  can  be  easily 
established  upon  the  basis  of  this  doctrine. 

(c)  That  the  successful  carrying  out  of  such  plan  depends  upon  a  thorough 
understanding  of  the  mosquito  doctrine  by  the  people,  and  upon  the  support 
that  they  may  give  to  the  prompt  and  frank  reporting  and  the  proper  handling 
of  the  first  cases,  and  of  all  suspicious  cases. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  12$ 

(d)  That  the  convention  expresses  its  censure  of  the  sanitary  authorities  that 
do  not  report  in  due  time  the  presence  of  yellow  fever  in  their  territory. 

O)  That  the  congratulations  of  the  convention  be  extended  to  the  Republics 
of  Mexico  and  Cuba  and  to  the  Canal  Zone  of  Panama  for  the  success  attained, 
and  also  to  the  Public  Health  and  Marine-Hospital  service  for  the  brilliant 
work  done  in  New  Orleans;  and  be  it  further 

(f)  Resolved,  That  in  the  opinion  of  this  convention  all  maritime  quarantine 
and  the  management  of  all  epidemics  that  threaten  to  extend  to  neighboring 
States  and  countries  should  be  placed  in  the  hands  of  the  national  Health 
authorities. 

IV. 

(a)  Resolved,  That  a  vote  of  thanks  be  extended  by  the  International  Sanitary 
Convention  of  the  American  Republics  to  His  Excellency  Theodore  Roosevelt, 
the  President  of  the  United  States  of  America,  for  his  valued  co-operation  to 
the  success  of  this  conference  and  for  the  high  meaning  of  the  expressions  of 
the  cordial  address  with  which  he  greeted  the  delegates  to  this  convention  at 
the  reception  he  accorded  to  them  at  the  White  House  on  the  I2th  instant. 

(6)  Resolved,  That  a  vote  of  thanks  be  extended  to  the  honorable  the  Secretary 
of  State,  and  to  the  honorable  the  Acting  Secretary  of  the  Treasury,  for  their 
addresses  of  welcome  at  the  inauguration  of  this  convention. 

(c)  Resolved,  That  a  vote  of  thanks  be  extended  to  the  Hon.  Gonzalo  de 
Quesada,  minister  plenipotentiary  from  Cuba. 

(d)  Resolved,  That  a  vote  of  thanks  be  extended  to  Director  Fox,  as  represent- 
ing the  Bureau  of  the  American  Republics,  for  his  attentions  to  the  delegates  and 
for  the  arrangements  made  for  their  entertainment. 

(^)  Resolved,  That  an  expression  of  our  sincere  appreciation  be  given  to  our 
highly  esteemed  president,  Surgeon-General  Wyman,  for  his  kind  treatment 
and  for  the  efficient  manner  in  which  he  has  complied  with  his  official  duties. 

(f)  Resolved,  That  a  vote  of  thanks  be  extended  to  the  Cosmos  Club  and  to  the 
press  of  the  city  of  Washington  for  the  courteous  manner  in  which  they  have 
treated  us  during  our  stay  at  this  capital. 

(g~)  Resolved,  That  a  vote  of  thanks  be  extended  in  the  name  of  the  delegates 
from  the  Spanish  American  Republics  to  the  delegates  from  the  United  States 
for  their  hospitality  and  excellent  fellowship. 


CONVENTION  AD  REFERENDUM  CONCLUDED  AT  THE  SECOND 
GENERAL  INTERNATIONAL  SANITARY  CONVENTION  OF  THE 
AMERICAN  REPUBLICS,  IN  WASHINGTON,  ON  OCTOBER  14,  1905. 

The  Presidents  of  the  Republics  of  Chile,  Costa  Rica,  Cuba,  Dominican  Repub- 
lic, Ecuador,  Guatemala,  Mexico,  Nicaragua,  Peru,  United  States  of  America,  and 
Venezuela,  having  found  that  it  is  useful  and  convenient  to  codify  all  the  meas- 
ures destined  to  guard  the  public  health  against  the  invasion  and  propagation  of 
yellow  fever,  plague,  and  cholera,  have  designated  as  their  delegates,  to  wit: 

Republic  of  Chile,  Senor  Dr.  D.  Eduardo  Moore,  professor  of  the  medical 
faculty,  hospital  physician; 

Republic  of  Costa  Rica,  Senor  Dr.  D.  Juan  J.  Ulloa,  ex-vice-president,  ex- 
minister  of  the  interior  of  Costa  Rica,  ex-president  of  the  medical  faculty  of 
Costa  Rica ; 

Republic  of  Cuba,  Senor  Dr.  D.  Juan  Guiteras,  member  of  the  superior  board 
of  health  of  Cuba,  director  of  the  "Las  Animas"  Hospital,  professor  of  general 
pathologv  and  tropical  medicine  of  the  University  of  Habana,  and  Senor  Dr.  D. 
Enrique  B.  Barnet,  executive  chief  of  the  health  department  of  Habana,  mem- 
ber and  secretary  of  the  superior  board  of  health  of  Cuba ; 

Republic  of  Ecuador,  Senor  Dr.  D.  Serafin  S.  Wither,  charge  d'Affaires  and 
consul-general  of  Ecuador  in  New  York,  and  Senor  Dr.  D.  Miguel  H.  Alcivar, 
member  of  the  superior  board  of  health  of  Guayaquil,  professor  of  the  medical 
faculty  and  surgeon  of  the  General  Hospital  of  Guayaquil ; 

Republic  of  the  United  States  of  America,  Dr.  Walter  Wyman,  Surgeon- 
General  of  the  Public  Health  and  Marine-Hospital  Service  of  the  United  States ; 
Dr.  H.  D.  Geddings,  Assistant  Surgeon-General  of  the  Public  Health  and 
Marine-Hospital  Service  of  the  United  States  and  representative  of  the  United 


126  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

States  at  the  sanitary  convention  of  Paris;  Dr.  J.  F.  Kennedy,  secretary  of  the 
board  of  health  of  the  State  of  Iowa;  Dr.  John  S.  Fulton,  secretary  of  the 
board  of  health  of  the  State  of  Maryland;  Dr.  Walter  D.  McCaw,  major-surgeon 
in  the  United  States  Army;  Dr.  J.  D.  Gatewood,  surgeon  in  the  United  States 
Navy;  Dr.  H.  L.  E.  Johnson,  member  of  the  American  Medical  Association 
(member  of  the  board  of  trustees)  ; 

Republic  of  Guatemala,  Senor  Dr.  D.  Joaquin  Yela,  consul-general  of  Guate- 
mala -in  New  York ; 

Republic  of  Mexico,  Senor  Dr.  D.  Eduardo  Liceaga,  president  of  the  superior 
council  of  health  of  Mexico,  director  and  professor  of  the  National  School  of 
Medicine,  member  of  the  Academy  of  Medicine ; 

Republic  of  Nicaragua,  Senor  Dr.  D.  J.  L.  Medina,  member  of  the  Second 
Pan-American  Medical  Congress  of  the  city  of  Habana  in  1901 ; 

Republic  of  Peru,  Senor  Dr.  D.  Daniel  Eduardo  Lavoreria,  professor  of  the 
medical  faculty,  member  of  the  National  Academy  of  Medicine,  physician  of  the 
"Dos  de  Mayo"  Hospital,  chief  of  the  division  of  hygiene  of  the  ministry  of 
f  omentp ; 

Dominican  Republic,  Senor  D.  Emilio  C.  Joubert,  minister  resident  in  Wash- 
ington ; 

Republic  of  Venezuela,  Senor  D.  Nicolas  Veloz-Goiticoa,  charge  d'affaires 
of  Venezuela, 

Who,  having  made  an  interchange  of  their  powers  and  found  them  good,  have 
agreed  to  adopt,  ad  referendum,  the  following  propositions : 

CHAPTER  I. 

REGULATIONS    TO   BE   OBSERVED   BY   THE   POWERS    SIGNATORY    TO   THE   CONVENTION    AS 
SOON  AS  PLAGUE,  CHOLERA,  OR  YELLOW  FEVER  MAY  APPEAR  IN  THEIR  TERRITORY. 

SECTION  I. — Notification  and  subsequent  communications  to  other  countries. 

ARTICLE  I.  Each  Government  should  immediately  notify  other  Governments 
of  the  first  appearance  in  its  territory  of  authentic  cases  of  plague,  cholera,  or 
yellow  fever. 

ART.  II.  This  notification  is  to  be  accompanied,  or  very  promptly  followed, 
by  the  following  additional  information: 

1.  The  neighborhood  where  the  disease  has  appeared. 

2.  The  date  of  its  appearance,  its  origin,  and  its  form. 

3.  The  number  of  established  cases  and  the  number  of  deaths. 

4.  For  plague — the  existence  among  rats  or  mice  of  plague,  or  of  an  unusual 
mortality;  for  yellow  fever — the  existence  of  Stegomyia  fasciata  in  the  locality. 

5.  The  measures  taken  immediately  after  the  first  appearance. 

ART.  III.  The  notification  and  the  information  prescribed  in  Articles  I  and  II 
are  to  be  addressed  to  diplomatic  and  consular  agents  in  the  capital  of  the 
infected  country;  but  this  is  to  be  construed  as  not  preventing  direct  communi- 
cation between  officials  charged  with  the  public  health  of  the  several  countries. 

For  countries  which  are  not  thus  represented,  they  are  to  be  transmitted 
directly  by  telegraph  to  the  Governments  of  such  countries. 

ART.  IV.  The  notification  and  the  information  prescribed  in  Articles  I  and  II 
are  to  be  followed  by  further  communications  dispatched  in  a  regular  manner  in 
order  to  keep  the  Governments  informed  of  the  progress  of  the  epidemic. 

These  communications,  which  are  to  be  made  at  least  once  a  week,  and  which 
are  to  be  as  complete  as  possible,  should  indicate  in  detail  the  precautions  taken 
to  prevent  the  extension  of  the  disease. 

They  should  set  forth,  first,  the  prophylactic  measures  taken  relative  to  sani- 
tary or  medical  inspection,  to  isolation,  and  disinfection;  second,  the  measures 
taken  relative  to  departing  vessels  to  prevent  the  exportation  of  the  disease,  and, 
especially  under  the  circumstances  mentioned  in  paragraph  4  of  Article  II  of  this 
section,  the  measures  taken  against  rats  and  mosquitoes. 

ART.  V.  The  prompt  and  faithful  execution  of  the  preceding  provisions  is  of 
the  very  first  importance. 

The  notifications  only  have  a  real  value  if  each  Government  is  warned  in 
time  of  cases  of  plague,  cholera,  or  yellow  fever  and  of  suspicious  cases  of  those 
diseases  supervening  in  its  territory.  It  can  not,  then,  be  too  strongly  recom- 
mended to  the  various  Governments  to  make  obligatory  the  declaration  of  cases 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  127 

of  plague,  cholera,  or  yellow  fever,  and  of  giving  information  of  all  unusual 
mortality  of  rats  and  mice,  especially  in  ports. 

ART.  VI.  —  It  is  understood  that  neighboring  countries  reserve  to  themselves 
the  right  to  make  special  arrangements  with  a  view  of  organizing  a  service  of 
direct  information  between  the  chiefs  of  administration  upon  the  frontiers. 

SECTION  II.—  Conditions  showing  a  given  territorial  area  to  be  infected  or  to 
have  been  freed  from  infection. 

ART.  VII.  Information  of  a  first  case  of  plague,  cholera,  or  yellow  fever  does 
not  justify  against  a  territorial  area  where  it  may  appear  the  application  of  the 
measures  prescribed  in  Chapter  II,  as  hereinafter  indicated. 

Upon  the  occurrence  of  several  nonimported  cases  of  plague  or  a  nonimported 
case  of  yellow  fever  or  when  cases  of  cholera  form  a  focus  the  area  is  to  be 
declared  infected. 

ART.  VIII.  —  To  limit  the  measures  to  the  affected  regions  alone,  Governments 
should  only  apply  them  to  persons  and  articles  proceeding  from  the  contaminated 
or  infected  areas. 

By  the  word  "area"  is  understood  a  well  determined  portion  of  territory 
described  in  the  information  which  accompanies  or  follows  notification;  thus,  a 
province,  a  state,  "a  government,"  a  district,  a  department,  a  canton,  an  island, 
a  commune,  a  city,  a  quarter  of  a  city,  a  village,  a  port,  a  "polder,"  a  hamlet, 
etc.,  whatever  may  be  the  extent  and  population  of  these  portions  of  territory. 

But  this  restriction,  limited  to  the  infected  area,  should  only  be  accepted  upon 
the  formal  condition  that  the  Government  of  the  infected  country  shall  take 
the  necessary  measures,  i,  to  prevent,  unless  previously  disinfected,  the  exporta- 
tion of  articles  named  in  i  and  2  of  Article  XII  coming  from  the  contaminated 
area  ;  and  2,  measures  to  prevent  the  extension  of  the  epidemic  ;  and  provided 
further,  that  there  be  no  doubt  that  the  sanitary  authorities  of  the  infected 
country  have  faithfully  complied  with  Article  I  of  this  convention. 

When  an  area  is  infected,  no  restrictive  measure  is  to  be  taken  against  de- 
partures from  this  area  if  these  departures  have  occurred  five  days,  at  least, 
before  the  beginning  of  the  epidemic. 

ART.  IX.  That  an  area  should  no  longer  be  considered  as  infected,  official 
proof  must  be  furnished  : 

First,,  that  there  has  been  neither  a  death  nor  a  new  case  of  plague  or  cholera 
for  five  days  after  isolation,1  death,  or  cure  of  the  last  plague  or  cholera  case. 
In  the  case  of  yellow  fever  the  period  shall  be  eighteen  days,  but  each  Govern- 
ment may  reserve  the  right  to  extend  this  period. 

Second,  that  all  the  measures  of  disinfection  have  been  applied;  in  the  case  of 
plague,  that  the  precautions  against  rats  have  been  observed,  and  in  the  case 
of  yellow  fever  that  the  measures  against  mosquitoes  have  been  executed. 

CHAPTER  II. 

MEASURES    OF   DEFENSE   BY   OTHER   COUNTRIES   AGAINST   TERRITORIES    DECLARED   TO   BE 

INFECTED. 

SECTION  I.  —  Publication  of  prescribed  measures. 

ART.  X.  The  Government  of  each  country  is  obliged  to  immediately  publish 
the  measures  which  it  believes  necessary  to  take  against  departures  either  from 
a  country  or  from  an  infected  territorial  area. 

The  said  Government  is  to  communicate  at  once  this  publication  to  the  diplo- 
matic or  consular  agent  of  the  infected  country  residing  in  its  capital,  as  well  as 
to  the  International  Sanitary  Bureau. 

The  Government  shall  be  equally  obliged  to  make  known  through  the  same 
channels  the  revocation  of  these  measures  or  modifications  which  may  be  made 
in  them. 

In  default  of  a  diplomatic  or  consular  agency  in  the  capital,  communications 
are  made  directly  to  the  Government  of  the  country  interested. 


word  "isolation"  signifies  isolation  of  the  patient,  of  the  persons  who  care  for  him, 
and  the  forbidding  of  visits  of  all  other  persons,  the  physician  excepted.  By  isolation  in  the 
case  of  yellow  fever  is  understood  the  isolation  of  the  patient  in  an  apartment  so  screened 
as  to  prevent  the  access  of  mosquitoes. 


128  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

SECTION   II. — Merchandise — Disinfection — Importation  and  transit — Baggage. 

ART.  XL  There  exists  no  merchandise  which  is  of  itself  capable  of  transmit- 
ting plague,  cholera,  or  yellow  fever.  It  only  becomes  dangerous  in  case  it  is 
soiled  by  pestous  or  choleraic  products,  or,  in  the  case  of  yellow  fever,  when 
such  merchandise  may  harbor  mosquitoes. 

ART.  XII.  No  merchandise  or  objects  shall  be  subjected  to  disinfection  on 
account  of  yellow  fever,  but  in  cases  covered  by  the  previous  article  the  vehicle 
of  transportation  may  be  subjected  to  fumigation  to  destroy  mosquitoes.  In  the 
case  of  cholera  and  plague  disinfection  should  only  be  applied  to  merchandise 
and  objects  which  the  local  sanitary  authority  considers  as  infected. 

Nevertheless,  merchandise  or  objects  enumerated  hereafter  may  be  subjected 
to  disinfection  or  prohibited  entry,  independently  of  all  proof  that  they  may  or 
may  not  be  infected: 

1.  Body  linen,  wearing  apparel  in  use,  clothing  which  has  been  worn,  bedding 
already  used. 

When  these  objects  are  transported  as  baggage,  or  in  the  course  of  a  change 
of  residence  (household  furniture),  they  should  not  be  prohibited,  and  are  to 
be  subjected  to  the  regulations  prescribed  by  Article  XIX. 

Baggage  left  bv  soldiers  and  sailors  and  returned  to  their  country  after  death 
are  considered  as  objects  comprised  in  the  first  paragraph  of  No.  I  of  this 
article. 

2.  Rags,  and  rags  for  making  paper,  with  the  exception,  as  to  cholera,  of 
rags  which  are  transported  as  merchandise  in  large  quantities  compressed  in 
bales  held  together  by  hoops. 

New  clippings  coming  directly  from  spinning  mills,  weaving  mills,  manufac- 
tories or  bleacheries,  shoddy,  and  clippings  of  new  paper,  should  not  be  for- 
bidden. 

ART.  XIII.  In  the  case  of  cholera  and  plague  there  is  no  reason  to  forbid  the 
transit  through  an  infected  district  of  merchandise  and  the  objects  specified  in 
Nos.  i  and  2  of  the  preceding  article  if  they  are  so  packed  that  they  can  not 
have  been  exposed  to  infection  in  transit. 

In  like  manner,  when  merchandise  or  objects  are  so  transported  that  in  transit 
they  can  not  come  in  contact  with  soiled  objects,  their  transit  across  an  infected 
territorial  area  should  not  be  an  obstacle  to  their  entry  into  the  country  of 
destination. 

ART.  XIV.  The  entry  of  merchandise  and  objects  specified  in  Nos.  i  and  2 
of  Article  XII  should  not  be  prohibited  if  it  can  be  shown  to  the  authorities  of 
the  country  of  destination  that  they  were  shipped  at  least  five  days  before  the 
beginning  of  the  epidemic. 

ART.  XV.  The  method  and  place  of  disinfection,  as  well  as  the  measures  to 
be  employed  for  the  destruction  of  rats  and  mosquitoes,  are  to  be  fixed  by 
authority  of  the  country  of  destination,  upon  arrival  at  said  destination.  These 
operations  should  be  performed  in  such  a  manner  as  to  cause  the  least  possible 
injury  to  the  merchandise. 

It  devolves  upon  each  country  to  determine  questions  relative  to  the  payment 
of  damages  resulting  from  disinfection  or  from  the  destruction  of  rats  or  mos- 
quitoes. 

If  taxes  are  levied  by  a  sanitary  authority,  either  directly  or  through  the 
agency  of  any  company  or  agent,  to  insure  measures  for  the  destruction  of  rats 
and  mosquitoes  on  board  ships,  the  amount  of  these  taxes  ought  to  be  fixed  by 
a  tariff  published  in  advance,  and  the  result  of  these  measures  should  not  be  a 
source  of  profit  for  either  State  or  sanitary  authorities. 

ART.  XVI.  Letters  and  correspondence,  printed  matter,  books,  newspapers, 
business  papers,  etc.  (postal  parcels  not  included),  are  not  to  be  submitted  to 
any  restriction  or  disinfection.  In  case  of  yellow  fever  postal  parcels  are  not 
to  be  subjected  to  any  restrictions  or  disinfection. 

ART.  XVII.  Merchandise  arriving  by  land  or  by  sea  should  not  be  detained 
permanently  at  frontiers  or  in  ports. 

Measures  which  it  is  permissible  to  prescribe  with  respect  to  them  are  specified 
in  Article  XII. 

Nevertheless,  when  merchandise,  arriving  by  sea  in  bulk  (vrac)  or  in  defec- 
tive packages,  is  contaminated  by  pest-stricken  rats  during  the  passage  and  is 
incapable  of  being  disinfected,  the  destruction  of  the  germs  may  be  assured 
by  putting  said  merchandise  in  a  warehouse  for  a  period  to  be  decided  by  the 
sanitary  authorities  of  the  port  of  arrival. 

It  is  to  be  understood  that  the  application  of  this  last  measure  should  not 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  I2Q 

entail  delay  upon  any  vessel  nor  extraordinary  expenses  resulting  from  the  want 
of  warehouses  in  ports. 

ART.  XVIII.  When  merchandise  has  been  disinfected  by  the  application  of 
the  measures  prescribed  in  Article  XII,  or  put  temporarily  in  warehouses  in 
accordance  with  the  third  paragraph  of  Article  XVII,  the  owner  or  his  repre- 
sentative has  the  right  to  demand  from  the.  sanitary  authority  which  has  ordered 
such  disinfection  or  storage  a  certificate  setting  forth  the  measures  taken. 

ART.  XIX.  Baggage.  In  the  case  of  soiled  linen,  bed  clothing,  clothing,  and 
objects  forming  a  part  of  baggage  or  furniture  coming  from  a  territorial  area 
declared  contaminated,  disinfection  is  only  to  be  practiced  in  cases  where  the 
sanitary  authority  considers  them  as  contaminated.  There  shall  be  no  disinfec- 
tion of  baggage  on  account  of  yellow  fever. 

SECTION  III.  —  Measures  in  ports  and  at  maritime  frontiers. 

ART.  XX.  Classification  of  ships.  A  ship  is  considered  as  infected  which  has 
plague,  cholera,  or  yellow  fever  on  board,  or  which  has  presented  one  or  more 
cases  of  plague  or  cholera  within  seven  days  or  a  case  of  yellow  fever,  at  any 
time  during  the  voyage. 

A  ship  is  considered  as  suspected  on  board  of  which  there  have  been  a  case 
or  cases  of  plague  or  cholera  at  the  time  of  departure  or  during  the  voyage, 
but  no  new  case  within  seven  days;  also  such  ships  as  have  lain  in  such  prox- 
imity to  the  infected  shore  as  to  render  them  liable  to  the  access  of  mosquitoes. 

The  ship  is  considered  indemne  which,  although  coming  from  an  infected 
port,  has  had  neither  death  nor  case  of  plague,  cholera,  or  yellow  fever  on 
board,  either  before  departure,  during  the  voyage,  or  at  the  time  of  arrival, 
and  which  in  the  case  of  yellow  fever  has  not  lain  in  such  proximity  to  the 
shore  as  to  render  it  liable,  in  the  opinion  of  the  sanitary  authorities,  to  the 
access  of  mosquitoes. 

ART.  XXI.  Ships  infected  with  plague  are  to  be  subjected  to  the  following 
regulations  : 

1.  Medical  visit   (inspection). 

2.  The  sick  are  to  be  immediately  disembarked  and  isolated. 

3.  Other  persons  should  also  be  disembarked,  if  possible,  and  subjected  to  an 
observation,1  which  should  rot  exceed  five  days  dating  from  the  day  of  arrival. 

4.  Soiled  linen,  personal  effects  in  use,  the  belongings  of  crew2  and  passengers 
which,  in  the  opinion  of  the  sanitary  authorities  are  considered  as  infected, 
should  be  disinfected. 

5.  The  parts  of  the  ship  which  have  been  inhabited  by  those  stricken  with 
plague,  and  such  others  as,  in  the  opinion  of  the  sanitary  authorities  are  con- 
sidered as  infected,  should  be  disinfected. 

6.  The  destruction  of  rats  on  shipboard  should  be  effected  before  or  after  the 
discharge  of  cargo  as  rapidly  as  possible,  and  in  all  cases  with  a  maximum  delay 
of  forty-eight  hours,  care  being  taken  to  avoid  damage  of  merchandise,  the  vessel 
and  its  machinery. 

For  ships  in  ballast  this  operation  should  be  performed  immediately  before 
taking  on  cargo. 

ART.  XXII.  Ships  suspected  of  plague  are  to  be  subjected  to  the  measures 
which  are  indicated  in  Nos.  I,  4  and  5  of  Article  XXI. 

Further,  the  crew  and  passengers  may  be  subjected  to  observation,  which 
should  not  exceed  five  days,  dating  from  the  arrival  of  the  ship.  During  the 
same  time  the  disembarkment  of  the  crew  may  be  forbidden,  except  for  reasons 
of  duty. 

The  destruction  of  rats  on  shipboard  is  recommended.  This  destruction  is  to 
be  effected  before  or  after  the  discharge  of  cargo,  as  quickly  as  possible,  and 
in  all  cases  with  a  maximum  delay  of  forty-eight  hours,  taking  care  to  avoid 
damage  to  merchandise,  ships  and  their  machinery. 

For  ships  in  ballast  this  operation  should  be  done,  if  done  at  all,  as  early  as 
possible,  and  in  all  cases  before  taking  on  cargo. 

^\RT.  XXIII.  Ships  indemne  from  plague  are  to  be  admitted  to  free  pratique 
immediately,  whatever  may  be  the  nature  of  their  bill  of  health. 


word  "observation"  signifies  isolation  of  the  passengers,  either  on  board  ship  or  at  a 
sanitary   station,   before   being   given   free   pratique. 

The  term  "crew"  is  applied  to  persons  who  may  make  or  who  have  made  a  part  of  the 
personnel  of  the  vessel  and  of  the  administration  thereof,  including  stewards,  waiters, 
"cafedji,"  etc.  The  word  is  to  be  construed  in  this  sense  wherever  employed  in  the  present 
Convention. 


£3O  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

The  only  regulation  which  the  sanitary  authorities  at  a  port  of  arrival  may 
prescribe  for  them  consists  of  the  following  measures : 

1.  Medical  visit  (inspection). 

2.  Disinfection  of  soiled  linen,  articles  of  wearing  apparel,  and  the  other  per- 
sonal effects  of  the  crew  and  passengers,  but  only  in  exceptional  cases,  when  the 
sanitary  authorities  have  special  reason  to  believe  them  infected. 

3.  Without  demanding  it  as  a  general  rule,  the  sanitary  authorities  may  sub- 
ject ships  coming  from  an  infected  port  to  a  process  for  the  destruction  of  the 
rats  on  board  before  or  after  the  discharge  of  cargo.    This  operation  should  be 
done  as  soon  as  possible,  and  in  all  cases  should  not  last  more  than  twenty- 
four  hours,  care  being  taken  to  avoid  damaging  merchandise,  ships  and  their 
machinery,  and  without  interfering  with  the  passing  of  passengers  and  crew 
between  the  ship  and  the  shore.     For  ships  in  ballast  this  procedure,  if  prac- 
ticed, should  be  put  in  operation  as  soon  as  possible,  and  in  all  cases  before 
taking  on  cargo. 

When  a  ship  coming  from  an  infected  port  has  been  subjected  to  a  process 
for  the  destruction  of  rats,  this  process  should  only  be  repeated  if  the  ship  has 
touched  meanwhile  at  an  infected  port  and  has  been  alongside  a  quay  in  such 
port,  or  if  the  presence  of  sick  or  dead  rats  on  board  is  proven. 

The  crew  and  passengers  may  be  subjected  to  a  surveillance,  which  should  not 
exceed  five  days,  to  be  computed  from  the  date  when  the  ship  sailed  from  the 
infected  port.  The  landing  of  the  crew  may  also,  during  the  same  time,  be 
forbidden  except  for  reasons  of  duty. 

Competent  authority  at  the  port  of  arrival  may  always  demand,  under  oath, 
a  certificate  of  the  ship's  physician,  or  in  default  of  a  physician,  of  the  captain, 
setting  forth  that  there  has  not  been  a  case  of  plague  on  board  since  departure 
and  that  no  marked  mortality  among  the  rats  has  been  observed. 

ART.  XXIV.  When  upon  an  indemne  ship  rats  have  been  recognized  as  pest 
stricken  as  a  result  of  bacteriological  examination,  or  when  a  marked  mortality 
has  been  established  among  these  rodents,  the  following  measures  should  be 
applied : 

1.  Ships  with  plague-stricken  rats : 
(a)  Medical  visit  (inspection). 

(fc)  Rats  should  be  destroyed  before  or  after  the  discharge  of  cargo  as  rapidly 
as  possible,  and  in  all  cases  with  a  delay  not  to  exceed  forty-eight  hours;  the 
deterioration  of  merchandise,  vessels  and  machinery  to  be  avoided.  Upon  ships 
in  ballast  this  operation  should  be  performed  as  soon  as  possible,  and  in  all 
cases  before  taking  on  cargo. 

(c)  Such  parts  of  the  ship  and  such  articles  as  the  local  sanitary  authority 
regards  as  infected  shall  be  disinfected. 

(d)  Passengers  and  crew  may  be  submitted  to  observation,  the  duration  of 
which  should  not  exceed  five  days,  dating  from  the  day  of  arrival,  except  in 
special  cases,  where  the  sanitary  authority  may  prolong  the  observation  to  a 
maximum  of  ten  days. 

2.  Ships  where  a  marked  mortality  among  rats  is  observed : 
(a)  Medical  visit  (inspection). 

(fr)  An  examination  of  rats,  with  a  view  to  determining  the  existence  of 
plague,  should  be  made  as  quickly  as  possible. 

(c)  If  the  destruction  of  rats  is  judged  necessary,  it  shall  be  accomplished 
under  the  conditions  indicated  above  in  the  case  of  ships  with  plague-stricken 
rats. 

(d)  Until  all  suspicion  may  be  eliminated,  the  passengers  and  crew  may  be 
submitted  to  observation,  the  duration  of  which  should  not  exceed  five  days, 
counting  from  the  date  of  arrival,  except  in  special*  cases,  when  the  sanitary 
authority  may  prolong  the  observation  to  a  maximum  of  ten  days. 

ART.  XXV.  The  sanitary  authorities  of  the  port  must  deliver  to  the  captain, 
the  owner,  or  his  agent,  whenever  a  demand  for  it  is  made,  a  certificate  setting 
forth  that  the  measures  for  the  destruction  of  rats,  have  been  efficacious  and  indi- 
cating the  reasons  why  these  measures  have  been  applied. 

ART.  XXVI.  Ships  infected  with  cholera  are  to  be  subjected  to  the  following 
regulations : 

1.  Medical  visit  (inspection). 

2.  The  sick  are  to  be  immediately  disembarked  and  isolated. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  13! 

3.  Other  persons  ought  also  to  be  disembarked,  if  possible,  and  subjected, 
dating  from  the  arrival  of  the  ship,  to  an  observation  the  duration  of  which 
shall  not  exceed  five  days. 

4.  Soiled  linen,  wearing  apparel,  and  personal  effects  of  crew  and  passengers 
which,  in  the  opinion  of  the  sanitary  authority  of  the  port,  are  considered  as 
infected,  are  to  be  disinfected. 

5.  The  parts  of  the  ship  which  have  been  inhabited  by  persons  sick  with 
cholera,  or  which  are  considered  by  the  sanitary  authority  as  infected,  are  to 
be  disinfected. 

6.  The  bilge  water  is  to  be  discharged  after  disinfection. 

The  sanitary  authority  may  order  the  substitution  of  good  potable  water  for 
that  which  is  contained  in  the  tanks  on  board. 

The  discharge  or  throwing  overboard  into  the  water  of  a  port,  of  dejecta, 
shall  be  forbidden  unless  they  have  been  previously  disinfected. 

ART.  XXVII.  Ships  suspected  of  cholera  are  to  be  subjected  to  measures  pre- 
scribed under  Nos.  i,  4,  5,  and  6  of  Article  XXVI. 

The  crew  and  passengers  may  be  subjected  to  an  observation,  which  should 
not  exceed  five  days,  to  date  from  the  arrival  of  the  ship.  It  is  recommended 
during  the  same  time  to  prevent  the  debarkation  of  the  crew  except  for  rea- 
sons of  duty. 

ART.  XXVII.  Ships  indemne  of  cholera  are  to  be  admitted  to  free  pratique 
immediately,  whatever  may  be  the  nature  of  their  bill  of  health. 

The  only  regulations  which  the  sanitary  authorities  of  a  port  may  prescribe 
in  their  case  are  the  measures  provided  in  Nos.  I,  4,  and  6  of  Article  XXVI. 

The  crews  and  passengers  may  be  submitted,  in  order  to  show  their  state  of 
health,  to  an  observation,  which  should  not  exceed  five  days,  to  be  computed 
from  the  date  when  the  ship  sailed  from  the  infected  port. 

It  is  recommended  that  during  the  same  time  the  debarkation  of  the  crew  be 
forbidden  except  for  reasons  of  duty. 

Competent  authority  at  the  port  of  arrival  may  always  demand,  under  oath, 
a  certificate  from  the  ship's  surgeon,  or,  in  the  absence  of  a  surgeon,  from  the 
captain,  setting  forth  that  there  has  not  been  a  case  of  cholera  upon  the  ship 
since  sailing. 

ART.  XXIX.  Competent  authority  will  take  account,  in  order  to  apply  the 
measures  indicated  in  Articles  XXI  to  XXVIII,  of  the  presence  of  a  physician, 
on  board  and  a  disinfecting  apparatus  in  ships  of  the  three  categories  mentioned 
above. 

In  regard  to  plague,  it  will  equally  take  account  of  the  installation  on  board 
of  apparatus  for  the  destruction  of  rats. 

Sanitary  authorities  of  such  countries,  where  it  may  be  convenient  to  make 
such  regulations,  may  dispense  with  the  medical  visit  and  other  measures  toward 
indemne  ships  which  have  on  board  a  physician  specially  commissioned  by  their 
country. 

ART.  XXX.  Special  measures  may  be  prescribed  in  regard  to  crowded  ships, 
notably  emigrant  ships,  or  any  other  ship  presenting  bad  hygienic  conditions. 

ART.  XXXI.  Any  ship  not  desiring  to  be  subjected  to  the  obligations  imposed 
by  the  authority  of  the  port  in  virtue  of  the  stipulations  of  the  present  convention 
is  free  to  proceed  to  sea. 

It  may  be  authorized  to  disembark  its  cargo  after  the  necessary  precautions 
shall  have  been  taken,  namely,  first,  isolation  of  the  ship,  its  crew  and  passengers ; 
second,  in  regard  to  plague,  demand  for  information  relative  to  the  existence 
of  an  unusual  mortality  among  rats ;  third,  in  regard  to  cholera,  the  discharge 
of  the  bilge  water  after  disinfection  and  the  substitution  of  a  good  potable 
water  for  that  which  is  provided  on  board  the  ship. 

Authority  may  also  be  granted  to  disembark  such  passengers  as  may  demand 
it,  upon  condition  that  these^  submit  themselves  to  all  measures  prescribed  by  the 
local  authorities. 

ART.  XXXII.  Ships  coming  from  a  contaminated  port,  which  have  been  disin- 
fected and  which  may  have  been  subjected  to  sanitary  measures  applied  in  an 
efficient  manner,  shall  not  undergo  a  second  time  the  same  measures  upon  their 
arrival  at  a  new  port,  provided  that  no  new  case  shall  have  appeared  since  the 
disinfection  was  practiced  and  that  the  ships  have  not  touched  in  the  meantime 
at  an  infected  port. 


132  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

When  a  ship  only  disembarks  passengers  and  their  baggage,  or  the  mails, 
without  having  been  in  communication  with  terra  firma,  it  is  not  to  be  considered 
as  having  touched  at  a  port,  provided  that  in  the  case  of  yellow  fever  it  has  not 
approached  sufficiently  near  the  shore  to  permit  the  access  of  mosquitoes. 

ART.  XXXIII.  Passengers  arriving  on  an  infected  ship  have  the  right  to  de- 
mand of  the  sanitary  authority  of  the  port  a  certificate  showing  the  date  of 
their  arrival  and  the  measures  to  which  they  and  their  baggage  have  been  sub- 
jected. 

ART.  XXXIV.  Packet  boats  shall  be  subjected  to  special  regulations,  to  be 
established  by  mutual  agreement  between  the  countries  in  interest. 

ART.  XXXV.  Without  prejudice  to  the  right  which  governments  possess  to 
agree  upon  the  organization  of  common  sanitary  stations,  each  country  should 
provide  at  least  one  port  upon  each  of  its  seaboards,  with  an  organization  and 
equipment  sufficient  to  receive  a  vessel,  whatever  may  be  its  sanitary  condition. 

When  an  indemnes  vessel,  coming  from  an  infected  port,  arrives  at  a  large 
mercantile  port,  it  is  recommended  that  she  be  not  sent  to  another  port  for 
the  execution  of  the  prescribed  sanitary  measures. 

In  every  country  ports  liable  to  the  arrival  of  vessels  from  ports  infected  with 
plague,  cholera,  or  yellow  fever  should  be  equipped  in  such  a  manner  that 
indemne  vessels  may  there  undergo,  immediately  upon  their  arrival,  the  pre- 
scribed measures,  and  not  be  sent  for  this  purpose  to  another  port. 

Governments  should  make  declaration  of  the  ports  which  are  open  in  their 
territories  to  arrivals  from  ports  infected  with  plague,  cholera,  or  yellow  fever. 

ART.  XXXVI.  It  is  recommended  that  in  large  seaports  there  be  established: 

(a)  A  regular  medical  service  and  a  permanent  medical  supervision  of  the 
sanitary  conditions  of  crews  and  the  inhabitants  of  the  port. 

(&)  Places  set  apart  for  the  isolation  of  the  sick  and  the  observation  of  sus- 
pected persons.  In  the  Stegomyia  belt  there  must  be  a  building  or  part  of  a 
building  screened  against  mosquitoes,  and  a  launch  and  ambulance  similarly 
screened. 

(c)  The  necessary   installation    for   efficient    disinfection   and   bacteriological 
laboratories. 

(d)  A  supply  of  potable  water  above  suspicion,  for  the  use  of  the  port,  and 
the  installation  of  a  system  of  sewerage  and  drainage  adequate  for  the  removal 
of  refuse. 

SECTION    IV. — Measures    upon    land    frontiers — Travelers — Railroads — Frontier 

zones — River  routes. 

ART.  XXXVII.  Land  quarantines  should  no  longer  be  established,  but  the 
governments  reserve  the  right  to  establish  camps  of  observation,  if  they  should 
be  thought  necessary,  for  the  temporary  detention  of  suspects. 

This  principle  does  not  exclude  the  right  for  each  country  to  close  a  part  of 
its  frontier  in  case  of  necessity. 

ART.  XXXVIII.  It  is  important  that  travelers  should  be  submitted  to  a  sur- 
veillance on  the  part  of  the  personnel  of  railroads,  to  determine  their  condition 
of  health. 

ART.  XXXIX.  Medical  intervention  is  limited  to  a  visit  (inspection),  with 
the  taking  of  temperature  of  travelers  and  the  succor  to  be  given  to  those  actu- 
ally sick.  If  this  visit  is  made,  it  should  be  combined  as  much  as  possible  with 
the  custom  house  inspection,  to  the  end  that  travelers  may  be  detained  as  short 
a  time  as  possible.  Only  persons  evidently  sick  should  be  subjected  to  a  search- 
ing medical  examination. 

ART.  XL.  As  soon  as  travelers  coming  from  an  infected  locality  shall  have 
arrived  at  their  destination,  it  would  be  of  the  greatest  utility  to  submit  them  to 
a  surveillance,  which  should  not  exceed  ten  or  five  days,  counting  from  the  date 
of  departure,  the  time  depending  upon  whether  it  is  a  question  of  plague  or 
cholera.  In  case  of  yellow  fever  the  period  should  be  six  days. 

ART.  XLI.  Governments  may  reserve  to  themselves  the  right  to  take  particular 
measures  in  regard  to  certain  classes  of  persons,  notably  vagabonds,  emigrants, 
and  persons  traveling  or  passing  the  frontier  in  bands. 

ART.  XLII.  Coaches  intended  for  the  transportation  of  passengers  and  mails 
should  not  be  retained  at  frontiers. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  133 

In  order  to  avoid  this  retention,  a  system  of  relays  ought  to  be  established  at 
frontiers,  with  transfer  of  passengers,  baggage,  and  mails.  If  one  of  these 
carriages  be  infected  or  shall  have  been  occupied  by  a  person  suffering  from 
plague,  cholera,  or  yellow  fever,  it  shall  be  detached  from  the  train  for  disin- 
fection at  the  earliest  possible  moment. 

ART,  XLIII.  Measures  concerning  the  passing  of  frontiers  by  the  personnel 
of  railroads  and  of  the  post-office  are  a  matter  for  agreement  of  the  sanitary 
authorities  concerned.  These  measures  should  be  so  arranged  as  not  to  hinder 
the  service. 

ART.  XLIV.  The  regulation  of  frontier  traffic,  as  well  as  the  adoption  of 
exceptional  measures  of  surveillance,  should  be  left  to  special  arrangement  be- 
tween contiguous  countries. 

ART.  XLV.  The  power  rests  with  governments  of  countries  bordering  upon 
rivers  to  regulate  by  special  arrangement  the  sanitary  regime  of  river  routes. 

ARTICLES  RELATING  TO  YELLOW  FEVER. 

ART.  XLVI.  Ships  infected  with  yellow  fever  are  to  be  subjected  to  the  follow- 
ing regulations: 

1.  Medical  visit   (inspection). 

2.  The  sick  are  to  be  immediately  disembarked,  protected  by  netting  against 
the  access  of  mosquitoes,  and  transferred  to  the  place  of  isolation  in  an  ambu- 
lance or  a  litter  similarly  screened. 

3.  Other  persons  should  also  be  disembarked,  if  possible,  and  subjected  to 
an  observation  of  six  days,  dating  from  the  day  of  arrival. 

4.  In  the  place  set  apart  for  observation  there  shall  be  screened  apartments 
or  cages  where  anyone  presenting  an  elevation  of  temperature  above  37.6  degrees 

C.  shall  be  screened  until  he  may  be  carried  in  the  manner  indicated  above  to 
the  place  of  isolation. 

5.  The  ship  shall  be  moored  at  least  200  meters  from  the  inhabited  shore. 

6.  The  ship  shall  be  fumigated  for  the  destruction  of  mosquitoes  before  the 
discharge  of  cargo,  if  possible.     If  a  fumigation  be  not  possible  before  the  dis- 
charge of  the  cargo,  the  health  authorities  shall  order,  either 

(a)  The  employment  of  immune  persons  for  discharging  the  cargo ;  or 

(fc)  If  nonimmunes  be  employed  they  shall  be  kept  under  observation  during 
the  discharging  of  cargo  and  for  six  days,  to  date  from  the  last  day  of  exposure 
on  board. 

ART.  XLVII.  Ships  suspected  of  yellow  fever  are  to  be  subjected  to  the  meas- 
ures which  are  indicated  in  Nos.  I,  3,  and  5  of  the  preceding  article ;  and  if  not 
fumigated,  the  cargo  shall  be  discharged  as  directed  under  subparagraph  (a)  or 
(b)  of  the  same  article. 

ART.  XLVIII.  Ships  indemne  from  yellow  fever,  coming  from  an  infected 
port,  after  the  medical  visit  (inspection)  shall  be  admitted  to  free  pratique,  pro- 
vided the  duration  of  the  trip  has  exceeded  six  days. 

If  the  trip  be  shorter,  the  ship  shall  be  considered  as  suspected  until  the 
completion  of  a  period  of  six  days,  dating  from  the  day  of  departure. 

If  a  case  of  yellow  fever  develop  during  the  period  of  observation,  the  ship 
shall  be  considered  as  infected. 

ART.  XLIX.  All  persons  who  can  prove  their  immunity  to  yellow  fever,  to  the 
satisfaction  of  the  health  authorities,  shall  be  permitted  to  land  at  once. 

ART.  L.  It  is  agreed  that,  in  the  event  of  a  difference  of  interpretation  of  the 
English  and  Spanish  texts,  the  interpretation  of  the  English  text  shall  prevail. 

TRANSITORY  DISPOSITION, 

The  governments  which  may  not  have, signed  the  present  convention  are  to 
be  admitted  to  adherence  thereo  upon  demand,  notice  of  this  adherence  to  be 
given  through  diplomatic  channels  to  the  Government  of  the  United  States  of 
America  and  by  the  latter  to  the  other  signatory  governments. 

Made  and  signed  in  the  city  of  Washington  on  the  I4th  day  of  the  month  of 
October,  1905,  in  two  copies,  in  English  and  Spanish  respectively,  which  shall 


134  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

be  deposited  in  the  State  Department  of  the  Government  of  the  United  States 
of  America,  in  order  that  certified  copies  thereof,  in  both  English  and  Spanish, 
may  be  made  to  transmit  them  through  diplomatic  channels  to  each  one  of  the 
signatory  countries. 

Dr.  EDUARDO  MOORE. 

JUAN  J.  ULLOA. 

JUAN  GUITERAS. 

E.   B.    BARNET. 

EMILIO  C.  JOUBERT. 

M.  H.  ALCIVAR. 

WALTER  D.  McCAw 

H.  D.   GEDDINGS. 

JOHN  S.  FULTON. 

WALTER  D.  MoCAw, 

J.  D.  GATEWOOD. 

H.  L.  E.  JOHNSON,  M.  D. 

JoAQuiN  YELA. 

E.   LlCEAGA, 

J.  L.  MEDINA,  M.  D. 
DANIEL  EDO.  LAVORERIA. 
N.  VELOZ-GOITICOA. 


RESOLUTIONS  ADOPTED  BY  THE  THIRD  INTERNATIONAL  SANI- 
TARY CONFERENCE,  HELD  IN  THE  CITY  OF  MEXICO  FROM  DE- 
CEMBER 2  TO  7,  1907- 

1.  To  request  the  representatives  of  the  Governments  of  Brazil,  Colombia,  and 
Uruguay  that,  in  accordance  with  the  full  powers  with  which  they  are  invested 
by  their  respective  governments,  they  approve  and  adhere  to  the  Sanitary  Con- 
vention of  Washington  of  1905. 

2.  To  recommend  to  the  Governments  of  the  American  Republics  represented 
in  this  Convention  the  codification  of  all  the  sanitary  laws  and  measures  of 
the  respective  countries,  and  as   soon  as  they  have  done   so  to  request   said 
governments  to  send  one  or  two  copies  of  said  codification  to  the  International 
Sanitary  Bureau  of  Washington. 

3.  To  authorize  the  International  Sanitary  Bureau  of  Washington  to  establish, 
by  such  means  as  it  may  deem  advisable,  relations  with  the  International  Sanitary 
Bureau  of  Paris,  to  carry  out  the  resolutions  of  the  Third  International  Conven- 
tion of  American  States,  held  in  Rio  de  Janeiro,  in  August,  1906. 

4.  To  authorize  the  Secretary  to  include  in  the  printed  transactions  of  the 
Third  International  Convention,  a  summary  of  all  the  resolutions  adopted  suc- 
cessively by  the  First  and  Second  International  Sanitary  Conventions  held  in 
Washington. 

5.  To  recommend  to  the  American  Governments  the  advisability  of  agreeing 
upon   compulsory  vaccination  against  smallpox. 

6.  To   recommend   to   the   governments    represented   at   this   convention    the 
advisability  of  declaring   free   of   fiscal   duties,   quinine    salts,   fine   mesh   wire 
guabe   used    for   protection   against   mosquitoes,    crude   petroleum,    ready-made 
mosquito  netting,  and  such  fabrics  as  are  used  in  the  manufacture  thereof. 

7.  To  recommend  that,  through  their  respective  sanitary  authorities,  the  gov- 
ernments carry  on  the  most  active  propaganda  possible,  concerning  ethiology, 
prophylaxis,  and  treatment  of  malaria,  and  that  they  reach  a  decision  concerning 
the  establishment  of  a  series  of  public  lectures  on  said  matters  in  the  schools, 
shops,  barracks,  etc. 

8.  To  recommend  that,  in  such  places  as  may  be  necessary,  centers  shall  be 
established  to  make  free  distribution  of  quinine  to  the  poor  in  such  quantities  as 
may  be  necessary  for  the  prophylaxis  of  malaria. 

9.  To  recommend  to  the  Governments  to  direct  the  maritime  sanitary  author- 
ities to  state  in  such  bills  of  health  as  they  issue,  the  mortality  caused  by  malaria. 

10.  To  instruct  the  International   Sanitary   Bureau  of   Washington   to  dis- 
tribute regularly  information  concerning  the  existence  of  malaria  in  their  several 
important  seaport  cities. 

11.  To  recommend  likewise  to  the  Governments  here  represented  the  publica- 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  135 

tion  of  a  pamphlet  wherein  shall  be  compiled,  in  a  brief,  simple  and  practical 
form,  and  in  such  manner  that  the  people  at  large  will  readily  understand  it, 
all  useful  information  concerning  malaria,  and  to  freely  distribute  said  pamphlet. 

12.  To  recommend  to  the  governments  here  represented  the  non-admittance 
to  their  respective  territories  of  immigrants  afflicted  with  trachoma  or  beri-beri. 

13.  To  recommend  to  the  American  nations  the  nationalization  and  centraliza- 
tion of  the  sanitary  authorities  by  means  of  proper  legislation. 

14.  To  recommend  to  the  American  Governments  the  following  provisions  for 
the  purpose   of  preventing  the   spread   of  tuberculosis   on   railroad   cars   and 
steamers. 

(A).  To  avoid,  as  far  as  possible,  the  use  of  fixed  carpets  and  curtains. 

(B).  To  recommend  the  use  of  cuspidors,  which  should  be  profusely  dis- 
tributed. 

(C).  The  periodical  disinfection  of  the  cars  or  berths,  including  furniture, 
beds,  wash  basins,  clothes,  etc.,  etc.;  this  disinfection  should  be  made  more 
especially  in  the  berths  of  steerage  passengers.  All  clothes,  including  napkins, 
should  be  disinfected  before  being  washed. 

(D).  The  disinfection  of  dining  room  utensils,  and,  in  addition,  to  direct  that 
napkins  for  the  use  of  passengers  be  always  kept  in  paper  bags  or  envelopes,  and 
to  recommend  that  the  food  be  kept  under  wire  gauze  covers,  and  that  the 
doors  and  windows  of  railroad  cars,  as  well  as  the  berths  and  state  rooms 
of  steamers,  be  protected  by  fine  wire  gauze  screens,  in  order  to  prevent  the 
entrance  of  flies. 

(E.)  The  examination  of  the  personnel  of  the  service,  both  on  the  railway 
passenger  cars  and  on  steamers,  in  order  not  to  employ  persons  afflicted 
with  tuberculosis. 

(F).  All  steamers  should  have  a  special  and  comfortable  department  for  the 
transportation  of  persons  afflicted  with  tuberculosis,  and  the  construction  of  said 
department  should  be  such  that  it  will  not  retain  any  dust. 

(G).  To  post  notices  in  conspicuous  places  prohibiting  the  habit  of  spitting 
on  the  floor. 

(H).  To  recommend  the  advisability  of  employing  on  board  physicians  who 
are  not  only  graduate  practitioners,  but  who  also,  if  possible,  shall  have  had 
special  training  concerning  the  prophylaxis  of  tuberculosis. 

15.  To  recommend  the  advisability  of  European  nations  adopting  the  Sanitary 
Convention  of  Washington  of  1905,  with  respect  to  such  colonies  as  they  have 
in  America,  and  especially  in  matters  relating  to  yellow  fever. 

16.  To  recommend  to  the  American  nations  that  the  bills  of  health  they  issue 
shall  contain  the  same  kind  of  information. 

17.  To  recommend  to  the  American  governments  the  advisability  of  estab- 
lishing separate  hospitals  for  the  treatment  of  consumptives,  and  whenever  this 
shall  not  be  possible,  to  establish  separate  pavillions  in  the  hospitals  for  the 
treatment  of  said  patients. 

18.  Whereas   the   international  prophylaxis   of  tuberculosis,   in   so   far   as   it 
relates  to  navigation  and  to  railway  communication,  should  be  the  result  of  a 
perfect  local  organization  of  the  countries  in  the  systematic  struggle  against 
such  disease,  the  Third  International  Sanitary  Convention  agrees  to  recommend 
to  the  governments  of  the  nations  here  represented,  the  generalization  of  the 
sanitary  measures  employed  against  the  invasion  of  said  disease. 

19.  In   view   of   the   great   advantages   to   be    derived   from   taking   sanitary 
measures  as  near  as  possible  to  a  contaminated  locality,  not  only  in  order  to 
avoid   the   introduction    of   cholera,   the   bubonic  plague    and   yellow    fever   in 
another  locality,  but  also  to  guard  the  lives  of  persons  on  board  the  vessel  which 
sailed  from  the  contaminated  port,  the  undersigned  delegate  proposes : 

That  the  next  convention  discuss  and  agree  as  to  the  provisions  to  which 
the  vessels,  cargoes,  and  passengers  shall  be  subjected  at  the  contaminated 
port  of  departure,  in  order  to  afford  the  greatest  possible  protection  to  passen- 
gers and  avoid  the  occurrence  of  cases  on  board. 

20.  Whereas,  The  Third  International  Conference  of  American  States,  held  at 
Rio  de  Janeiro  in  August,  1906,  by  resolution  declared  that  the  delegates  to  this 
International    Sanitary    Convention    in    Mexico    should    resolve    upon    practical 
means  for  the  adoption  of  measures  intended  to  obtain  the  sanitation  of  the 
cities,  and  especially  of  the  ports, 

Resolved,  That  this  subject  be  one  for  consideration  also  by  the  members  of 
the  next  International  Sanitary  Convention  of  American  Republics  to  be  held  in 


136  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Costa  Rica,  and  that  the  International  Sanitary  Bureau  in  Washington  be  au- 
thorized to  make  investigations  and  to  take  such  other  action  as  may  be  neces- 
sary to  present  this  matter  in  satisfactory  form  at  the  said  convention  in  Costa 
Rica. 

21.  Resolved,  That   an   office  be  provided   in   the   Bureau  of   the   American 
Republics  for  the  use  of  the  International  Sanitary  Bureau. 

That  authority  is  given  for  engaging  the  services  of  an  employee  who  shall 
be  paid  by  the  International  Bureau. 

That  the  expenses  incurred  shall  be  authorized  and  certified  to  bv  the  same 
Bureau. 

That  the  Bureau  of  the  American  Republics  be  entrusted  with  the  collection 
of  the  fund  provided  for  in  section  7  of  the  resolutions  relating  to  international 
sanitary  police,  adopted  by  the  Second  International  Conference  of  American 
States,  held  in  the  City  of  Mexico  in  1901-2. 

That  the  Bureau  of  the  American  Republics  be  likewise  entrusted  with  this 
fund  and  the  keeping  of  the  accounts. 

22.  That  at  the   next  meeting  of  the   International   Sanitary   Congress,   the 
model  documents  or  forms  to  be  employed  by  the  natio'ns  adhering  to  this  Con- 
vention, shall  be  discussed  and  approved  in  order  to  verify  the  same. 

23.  That  in  every  port  open  to  foreign  commerce  the  sanitary  authorities  shall 
issue  bills  of  health  to  all  vessels  applving  for  same,  and  in  accordance  with 
such  model  or  form  as  the  next  Convention  may  adopt. 

24.  That  a  Committee  be  appointed  to  give,  in  the  name  of  the  Third  Inter- 
national   Sanitary   Convention,   a   vote   of   thanks   to   His    Excellency   General 
Porfirio  Diaz,  President  of  the  Mexican  Republic,  for  his  important  co-operation 
in  the  success  of  this  Convention. 

25.  That  a  vote  of  thanks  be  extended  to  the  Vice-President,  and  to  the  Secre- 
taries of  State,  of  the  Treasury,  and  of  the  Interior  for  the  kind  attention 
shown  us. 

26.  That  a  vote  of  thanks  be  accorded  to  the  Superior  Council  of  the  Govern- 
ment of  the  Federal  District,  and  to  the  Municipal  Government  of  this  city 
for  the  kind  attentions  they  have  shown  us. 

27.  That  we   sincerely  thank  the   committee  of  ladies   who   have  so  kindly 
waited  on  the  wives  and  friends  of  the  foreign  delegates. 

28.  That  a  vote  of  thanks  be  given  to  the  Superior  Board  of  Public  Health  and 
to  the  Director  of  the  Water  Supply  Works  of  this  City  for  the  valuable  services 
they  have  rendered  us,  and 

29.  That  we  express  to  the  Mexican  delegates  to  this  Convention  our  deep 
appreciation  of  the  exquisite  courtesy  and  the  splendid  manner  in  which  they 
have  welcomed  us  to  their  country. 

Attest : 

JUAN  J.  ULLOA, 
Permanent  Secretary. 


DR.  WALTER  WYMAN,  OF  THE  UNITED  STATES, 

President   of  the   First   and   Second   International    Sanitary    Conventions    of 

American  Republics. 


REPORT  OF  DR.  OSWALDO  GONQALVEZ  CRUZ,  DELE- 
GATE OF  BRAZIL. 

The  sanitary  conditions  of  Brazil  are  improving  every  year  as  the  result  of 
the  campaign  waged  against  infectious  diseases,  and  the  material  improvements 
made  in  the  city  of  Rio  de  Janeiro,  which  has  been  the  principal  focus  of  in- 
fection for  Brazil. 

The  local  Boards  of  Health  in  the  principal  States  of  Brazil  have  succeeded 
in  maintaining  the  excellent  sanitary  conditions  of  the  country  and  of  its  ports. 

A  few  sporadic  cases  of  bubonic  plague  at  Rio  de  Janeiro,  and  of  yellow  fever 
at  Rio,  Nitheroy,  Para  and  Manaos,  were  the  diseases  which  required  special 
attention,  but  the  Government  is  confident  of  securing  their  complete  extinc- 
tion in  the  near  future. 

As  regards  Rio  de  Janeiro — the  former  great  focus  of  yellow  fever — we  may 
consider  the  disease  practically  extinct.  The  few  sporadic  cases  observed  had 
their  origin  in  small  foci  in  Nitheroy  which  faces  Rio  and  is  in  constant  com- 
munication with  it,  being  only  20  minutes  distant.  The  Federal  Government,  in 
conjunction  with  the  local  government,  has  taken  steps  to  stamp  out  the  disease, 
and  the  campaign  which  is  being  systematically  carried  on  in  that  city  is  giving 
excellent  results,  so  that  the  complete  extinction  of  yellow  fever  at  Rio  is  but 
a  question  of  a  few  more  months. 

The  problem  of  carrying  out  prophylactic  measures  against  yellow  fever  at 
Rio  was  a  most  difficult  one,  as  it  had  to  deal  with  a  city  which  is  very  broken 
and  hilly,  and  which  is  situated  on  the  sides  of  mountains,  thickly  covered 
with  vegetation,  which  covers  an  area  of  over  133  square  kilometers,  is  more  than 
60  kilometers  long,  and  from  4  to  5  kilometers  wide,  and  which  has  a  population 
of  over  811,000  inhabitants. 

As  regards  malaria,  the  prophylactic  measures  employed  have  been  based 
on  the  idea  of  its  sole  transmission  by  mosquitoes,  and  in  the  regions  where  such 
measures  have  been  put  into  effect  this  disease  has  greatly  diminished. 

Trachoma  was  observed  among  immigrants  in  some  localities  of  the  State 
of  Sao  Paulo.  The  sanitary  administration  of  Sao  Paulo,  which  is  one  of  the 
best  of  Brazil,  has  installed  a  special  prophylactic  service,  which  has  prevented 
the  spread  of  the  disease.  Immigrants  are  examined  at  the  ports  of  entry  to  pre- 
vent its  introduction  into  the  country. 

The  cases  of  beri-beri  observed  come  mainly  irom  the  upper  Amazon,  this 
disease  having  almost  entirely  disappeared  from  some  of  the  northern  ports  of 
Brazil,  such  as  Sao  Luiz  do  Maranhao,  where  it  formerly  made  great  ravages. 

In  short,  the  present  sanitary  condition  of  Rio  de  Janeiro  is  very  satisfac- 
tory. With  the  mortality  rate  at  21.7  per  1,000  inhabitants,  it  is  one  of  the 
healthiest  of  the  tropical  cities,  and  healthier  than  many  European  cities,  such 
as  Madrid,  Lisbon,  Athens,  Saint  Petersburg,  Naples  and  many  others. 

The  following  are  the  measures  which  have  been  adopted  in  Brazil  and  are 
being  vigorously  carried  out,  to  prevent  and  stamp  out  the  aforesaid  diseases : 

YELLOW  FEVER.  A  campaign  based  on  the  theory  of  its  sole  transmission  by 
the  Stegomyia  calopus,  without  regard  to  its  transmission  from  person  to  per- 
son by  contagion  or  through  the  medium  of  articles  which  have  been  contami- 
nated by  those  suffering  from  the  disease.  The  sanitary  administration  consists 
of  a  special  division  independent  of  the  other  sanitary  services  of  the  Union, 
which  is  under  the  jurisdiction  of  the  Director  General  of  the  Public  Health, 
and  consists  of  one  medical  inspector,  ten  assistant  inspectors,  who  are  physi- 
cians, 75  medical  students,  and  about  1,000  sanitary  guards.  The  personnel  is 
divided  into  three  divisions,  which  have  charge  of  the  following  services:  (a) 
The  isolation  of  those  suffering  from  the  disease  and  the  fumigation  of  the 
houses  occupied  by  them;  (b)  the  systematic  destruction  of  mosquitoes;  (c) 
the  fiscalization  of  the  therapeutic  agents  used,  the  verification  of  deaths  and 
medical  vigilance  over  persons  not  immune  residing  in  the  infected  center.  The 
systematic  and  continual  destruction  of  the  Stegomyia  is  the  principal  pro- 
phylactic measure  to  be  employed  against  yellow  fever.  Therefore  each  nation 
can,  of  itself,  by  destroying  the  Stegomyia,  defend  itself  absolutely  against 


138  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

epidemics  of  yellow  fever,  so  that  the  question  of  yellow  fever  loses  its  im- 
portance as  an  international  question  and  remains  one  of  purely  national  in- 
terest. In  accordance  with  these  principles,  sanitary  legislation,  from  an  inter- 
national point  of  view,  may  be  most  liberal,  but  should  be  most  rigorous  from 
a  national  point  of  view,  for  countries  whose  local  conditions  permit  the  pro- 
pagation of  the  Stegomyia;  while  on  the  other  hand  restrictive  measures  are 
perfectly  useless  in  countries  where  the  climatic  conditions  are  such  that  the 
transmitting  mosquito  can  not  exist.  In  countries  where  the  Stegomyia  exist, 
rigorous  measures  should  be  taken  for  their  extermination  and  to  prevent  the 
importation  of  new  generations  of  mosquitoes. 

BUBONIC  PLAGUE.  Bactericidal  and  parasitical  disinfection  by  means  of  phenol 
and  cresol  for  the  destruction  of  the  bacillus  and  of  the  transmitting  flea 
(Pulex  Cheops)  is  the  principal  means  employed.  This  is  effected  at  the  first 
appearance  of  the  disease  among  rats,  which  is  discovered  by  the  vigilance  ser- 
vice instituted  in  the  houses  or  communicated  to  the  health  authorities  by  inter- 
ested parties.  The  disinfection  is  effected  by  means  of  solutions  at  a  high  tem- 
perature, and  the  floors  of  the  houses  are  taken  up  to  disinfect  underneath. 
Another  measure  consists  in  the  extermination  of  rats  in  the  infected  centers, 
as  they  seem  to  increase  the  virulence  of  the  bacillus.  A  war  is  made  on  rats 
by  coating  the  ground  about  the  houses  adjoining  the  foci  with  cement,  and  by 
the  systematic  destruction  of  these  animals  by  a  special  sanitary  corps  in  charge 
of  this  service.  Inoculation  with  anti-plague  serum  for  the  prevention  of  this 
disease  is  made  whenever  permitted.  The  systematic  isolation  in  a  hospital  of  all 
persons  suffering  with  the  disease  and  the  disinfection  of  all  articles  which 
come  in  contact  with  the  patients,  complete  the  measures  employed.  The  treat- 
ment prescribed  consists  of  inoculation  with  the  serum  prepared  in  the  Institute 
of  Manguinhos,  which  reduced  the  mortality  from  this  disease  50  per  cent. 

MALARIA.  The  destruction  of  mosquitoes  in  the  cities  and  the  administration 
of  quinine  (30  centigrams  every  three  days),  wherever  large  groups  of  persons 
are  temporarily  residing  in  malarial  districts,  engaged  on  public  works,  such  as 
railways,  drainage  works,  etc.,  are  the  measures  which  have  been  adopted 
with  splendid  results  in  Brazil. 

TRACHOMA.  The  State  of  Sao  Paulo  has  organized  a  series  of  sanitary  sta- 
tions which  have  charge  of  the  service  of  diagnosing  and  treating  the  cases  of 
this  disease  which  have  been  found  among  immigrants  in  certain  sections  of 
this  State,  and  of  prescribing  the  necessary  prophylactic  measures  to  prevent  the 
spread  of  the  disease.  At  the  present  time  immigrants  are  inspected  at  the 
ports,  and  those  affected  with  the  disease  are  forbidden  entry. 

BERI  BERI.  The  prophylaxis  of  this  disease  is  empirical,  owing  to  the  lack 
of  any  scientific  basis  as  to  its  cause.  Vessels  carrying  cases  of  beri  beri  are 
thoroughly  fumigated  by  means  of  Clayton  gas.  In  addition  to  this  measure, 
barracks  and  prisons  are  required  to  make  alterations  in  their  buildings  so  as 
to  have  proper  conditions  of  light  and  air.  At  the  same  time  care  has  been 
taken  to  improve  the  quality  of  the  food  of  the  localities  attacked  by  the  disease. 

SANITARY  CONDITIONS   OF  THE  PORTS,   WORKS   ALREADY   CONSTRUCTED,   THOSE  IN    PRO- 
CESS OF  CONSTRUCTION,  OR  WHOSE  CONSTRUCTION  IS  PROPOSED. 

With  regard  to  the  maritime  sanitation  service,  the  ports  of  Rio  de  Janeiro 
and  Santos  have  a  complete  installation,  which  consists  of  a  floating  disinfecting 
station  equipped  with  a  Clayton  apparatus,  stoves,  compartments  f9r  disinfection 
by  means  of  sulphur  and  formaldehyde,  and  an  isolation  and  vigilance  hospital 
on  land.  In  great  emergencies  the  service  of  these  two  ports  is  aided  by  the  old 
lazaretto  of  Ilha  Grande,  which  has  been  transformed  into  a  disinfection  and 
observation  station.  Disinfecting  pontoons  are  in  course  of  construction  at 
the  parts  of  Bahia,  Para,  Maranhao  and  Rio  Grande  do  Sul,  and  should  be 
ready  for  operation  within  a  few  months.  The  lazaretto  of  Tamandare  at  Per- 
nambuco  has  been  transformed  into  a  disinfection  and  observation  station,  fully 
equipped,  and  has  charge  of  the  treatment  of  vessels  which  call  at  ports  between 
Bahia  and  Rio  Grande  do  Norte.  Vessels  bound^  for  the  north  of  Brazil  receive 
sanitary  treatment  at  the  Tatuoca  station  in  Para.  At  this  station,  as  well  as  at 
that  of  Tamandare  and  Ilha  Grande,  there  is  a  disinfection  plant  situated  on  land, 
an  isolation  hospital  and  pavilions  for  observation,  when  necessary  (jd  class 
passengers). 

The  great  engineering  works  which  have  been  constructed  in  the  ports  of 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  139 

Brazil  deserve  special  mention  as  they  are  of  sanitary  as  well  as  of  commercial 
importance.  The  port  of  Santos  is  equipped  with  docks  which  enable  vessels 
to  moor  alongside;  the  low  marshy  shores  which  formerly  existed  have  been 
filled  up  and  the  city  has  been  made  completely  sanitary  by  the  construction  of 
an  excellent  sewerage  system  and  water  works.  The  wharf  of  Santos  will  have, 
when  completed,  a  total  length  of  4,726.88  meters.  Active  work  is  being  done  on 
the  port  works  at  Rio  de  Janeiro,  500  meters  of  wharf  having  already  been 
opened  to  traffic. 

The  port  works  at  Manaos  are  almost  completed;  433  meters  of  wharf  have 
already  been  built,  there  remaining  only  158  meters  for  its  completion. 

Contracts  have  been  made  for  the  port  works  at  Belem,  Bahia  and  Rio  Grande 
do  Sul  and  the  work  of  construction  will  shortly  be  begun,  while  improvement 
works  are  projected  at  the  port  of  Victoria. 

The  Federal  Government  is  planning  a  project  to  be  submitted  to  the  National 
Congress,  for  the  complete  sanitary  organization  of  all  the  ports  of  Brazil.  In 
accordance  with  this  project,  the  Union  will  have  charge  of  the  maritime  and 
land  prophylaxis  against  all  infectious  diseases  and  all  the  ports  of  Brazil  will 
be  equipped  with  hospitals  and  disinfecting  stations,  the  plans  for  which  have 
already  been  made.  This  service  will  probably  be  organized  within  the  coming 
year  and  will  provide  Brazil  with  a  perfect  and  complete  sanitary  equipment. 
Twenty-four  ports  along  the  Brazilian  coast  will  thus  be  equipped  with  a  com- 
plete sanitary  service. 

WATER    SUPPLY. 

The  new  water  works  at  Rio  de  Janeiro  have  been  begun  and  the  work  of 
construction  is  being  actively  carried  forward.  When  completed,  the  city  will 
have  a  water  supply  of  360,000,000  liters  per  day,  or  an  average  of  over  440  liters 
per  inhabitant. 

SEWERS. 

The  principal  cities  of  Brazil  are  provided  with  sewerage  systems.  The  Gov- 
ernment is  planning  to  substitute  the  chemical  treatment  of  fecal  waters  now  in 
use  at  Rio  de  Janeiro,  by  a  biological  treatment.  For  this  purpose  it  has  ap- 
pointed a  commission  to  make  a  study  of  this  method,  and  it  is  now  making  care- 
ful experiments  in  a  bed  for  observation  installed  for  this  purpose. 

SANITATION   OF   HOUSES. 

This  service  is  rigorously  carried  out  in  accordance  with  the  sanitary  law 
of  January  5,  1904,  and  sanitary  regulations  of  March  8th,  of  the  same  year. 

It  is  already  referred  above  to  the  aid  which  the  Federal  Government  gives 
to  the  States  in  sanitary  matters. 

Brazil  continues  to  be  governed  by  the  sanitary  law  of  January  5,  1904,  which 
was  continued  in  force  by  a  resolution  of  Congress  of  this  year. 


REPORT  OF  DRS.  ERNESTO  SOZA  AND  PEDRO  LAUTARO 
FERRER,  DELEGATES  OF  CHILE. 

INFECTIOUS  DISEASES  IN  CHILE. 

The  provisional  programme  of  this  Convention  prescribes,  in  paragraph  (a), 
that  each  delegate  shall  present  a  report  on  the  existence  of  transmissible  dis- 
eases which  may  prevail  in  the  territory  of  the  country  represented  by  him, 
especially  with  reference  to  bubonic  plague,  yellow  fever,  cholera,  malaria,  beri- 
beri, and  trachoma,  giving  detailed  information  on  the  measures  which  have 
been  adopted  for  the  prevention  or  stamping  out  of  any  of  the  diseases  above 
mentioned. 

We  can  say  that,  of  the  diseases  referred  to,  only  the  bubonic  plague  has  in- 
vaded our  territory.  We  will  supplement  this  report  by  adding  a  few  lines  on 
other  infectious  diseases  of  a  similar  nature,  and  which  threaten  us,  such,  for 
instance,  as  the  small-pox. 


I4O  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

BUBONIC    PLAGUE. 

Chile  has  marked  the  ultimate  geographic  stop  in  the  advance  of  this  scourge, 
Tvhich  has  spread  throughout  all  latitudes  and  climates  of  the  earth. 

After  having  been  considered  by  many  hygienists  as  one  of  the  diseases  whose 
extinction  would  be  the  result  of  the  preventive  measures  of  modern  hygiene, 
it  has  reappeared  with  alarming  characteristics  in  the  civilized  world.  Its  new 
and  periodical  sorties,  from  its  four  endemic  foci  in  Asia,  were  initiated  in  1893 
by  invading  Europe  and  the  American  continent. 

In  1902  and  1903,  San  Francisco  and  San  Diego,  in  California,  Texas  and 
Todos  Santos  and  Mazatlan,  in  Mexico,  received  the  first  visits  of  the  disease, 
it  having  invaded  Peru  immediately  thereafter.  The  first  case  in  the  latter 
country  was  discovered  in  the  Port  of  Pisco  by  Doctor  Enrique  Mestanza,  whose 
diagnosis  thereon  was  sent  to  Professor  Doctor  Ernesto  Odriozola,  of  Lima, 
at  a  time  when  the  epidemic  was  invading  the  port  of  Callao.  Its  next  stop  was 
Iquique,  in  Chile,  attacking  simultaneously  Mollendo,  Pacasmayo,  Salavery, 
Tujillo,  and  several  other  localities  of  the  Peruvian  Republic. 

In  the  Orient,  Asuncion,  the  capital  of  Paraguay,  was  visited  by  the  plague 
in  1899,  invading  thereafter  Rosarip  de  Santa  Fe,  and  Buenos  Aires,  in  the 
Argentine  Republic,  and  appearing  simultaneously  in  Santos  and  Rio  de  Janeiro, 
in  Brazil,  and  in  other  northern  ports  of  the  southern  hemisphere. 

Iquique. — This  port,  situated  on  the  20°  12'  south  latitude,  and  70°  li'  west 
longitude,  was  infected  in  May,  1903. 

On  the  25th  of  the  same  month,  the  first  bacteriological  diagnosis  of  the 
plague  in  Iquique  was  made,  which  confirmed  the  reports  made  to  the  authori- 
ties by  physicians,  based  upon  clinic  diagnosis  carried  out  some  days  previous. 

The  epidemic  lasted  until  the  24th  of  September,  1903,  causing  the  following 
number  of  cases:  total,  214  (125  men,  and  89  women);  deaths,  135. 

Of  this  mortality,  38  died  within  the  first  twenty-four  hours  after  the  cases 
were  taken  into  the  lazaretto,  and  58  died  in  their  respective  houses  without 
receiving  the  serotherapic  treatment.  The  accompanying  map  shows  the  prin- 
cipal foci  of  the  epidemic  (Annex  I). 

The  danger  caused  by  this  epidemic  to  the  commercial  life  of  the  nitrate 
region,  compelled  the  authorities  to  take  energetic  measures  for  protection  against 
the  scourge.  A  committee  of  physicians,  presided  over  by  the  Director  of  the 
Institute  of  Hygiene,  and  composed  of  bacteriologists  and  hygienists  (among 
whom  were  physicians  that  had  been  sent  by  the  Chilean  Government  to  study 
the  plague  in  Rosario  de  Santa  Fe  in  1899),  was  sent  to  the  north,  with  the 
necessary  powers  to  organize,  conjointly  with  the  Intendente,  of  the  province 
and  the  representative  of  the  Executive,  the  necessary  sanitary  services.  Under 
this  committee  several  branches  were  operated,  such  as  the  Sanitary  Inspection, 
the  bacteriological  laboratory,  the  public  disinfecting  station,  the  isolation  house, 
the  lazaretto,  the  sanitary  commissariats,  the  sanitary  police,  etc.,  etc.,  as  well 
as  all  services  related  to  the  transit  of  passengers,  transportation  of  cargo  and 
baggage,  and  the  general  movement  of  the  port. 

The  Maritime  Sanitary  Regulations  of  1895  were  rigidly  enforced.  The  issu- 
ance of  sanitary  passports  was  prescribed,  and  the  disinfection  of  certain  pack- 
ages considered  as  suspicious,  such  as  bed  clothing,  clothes,  rags,  sacks,  leather 
articles,  etc.,  was  required.  The  port  physicians  were  placed  in  charge  of  this 
work,  in  accordance  with  the  provisions  of  the  Ordinance  of  Navigation  and 
Maritime  Health. 

One  of  the  efficient  measures  that  facilitated  to  a  great  extent  sanitary  investi- 
gations and  disinfections,  and,  consequently,  the  abatement  of  the  disease,  was 
the  strict  enforcement  of  the  law  compelling  physicians  to  report  all  cases  of 
infectious  diseases ;  this  law,  promulgated  on  the  7th  of  February,  1899,  provides, 
under  penalty  of  a  fine,  that  the  following  diseases  shall  be  reported  within 
twenty-four  hours  after  the  diagnosis,  certain  or  probable,  has  been  made: 
Cholera  morbus;  yellow  fever;  bubonic  plague;  diphtheria;  smallpox;  typhoid 
fever;  scarlet  fever,  and  leprosy. 

The  Superior  Council  of  Public  Health,  which  has  the  power  of  prescribing 
the  general  measures  of  prophylaxis,  insisted,  before  the  Central  Government, 
upon  the  necessity  of  the  establishment  of  a  Sanitary  station  in  the  northern 
part  of  the  Republic,  for  otherwise  it  would  have  been  necessary  to  suspend 
the  commercial  relations  with  the  countries  threatened  with  an  invasion  of  the 
disease.  The  establishment  of  another  sanitary  station  in  the  extreme  southern 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  14! 

section  of  the  country,  in  Agua  Fresca,  near  Punta  Arenas  in  the  Strait  of 
Magellan,  was  also  requested  to  protect  the  country  against  the  epidemics  of  the 
Atlantic. 

The  Superior  Council  of  Public  Health  requested  that  the  law  of  Sanitary 
Police  be  put  in  force;  this  law  gives  the  civil  and  sanitary  authorities  full 
powers  to  enforce  measures  of  defense  against  epidemics,  and  authorizes  the 
President  of  the  Republic  to  close  infected  or  suspicious  ports;  to  prescribe 
quarantines;  to  establish  sanitary  cordons;  to  declare  as  infected,  towns 
where  any  cases  of  contagious  diseases  may  have  occurred;  to  issue  sanitary 
ordinances;  to  prescribe  penalties  for  violations  thereof;  and  to  adopt  such 
sanitary  measures  as  he  may  deem  best  for  the  protection  of  public  health. 

After  four  months  of  struggle,  we  succeeded  in  stamping  out  the  first  epidemic 
at  Iquique. 

In  February,  1904,  the  plague  reappeared  in  a  port  further  south,  Antofagasta^ 
situated  on  the  23°  38'  south  latitude,  and  70°  22'  west  longitude. 

Within  the  period  of  five  months,  there  were  recorded  in  Antofagasta  185 
known  cases,  the  number  of  concealed  cases  being  estimated  at  about  35  per  cent. 

The  lazaretto  had  the  following  movement:  Total  number  of  cases  treated,. 
83 ;  deaths,  23.  Besides,  20  cadavers  of  plague-stricken  persons  were  found. 
These  cases  were  concealed  by  the  families. 

Valparaiso. — The  first  cases  that  occurred  in  this  port  were  caused  by  infection 
imported  from  Callao,  in  1903,  by  the  S.  S.  "Colombia,"  and  in  1904,  by  the 
S.  S.  "Limari."  A  few  cases  were  recorded  in  May  of  the  current  year. 

It  has  been  fully  proven  that  the  infection  was  caused  by  the  captains  and  a 
physician  of  the  two  mentioned  steamers,  who  had  concealed  cases  of  plague 
that  had  occurred  on  board  the  vessels,  thus  violating  the  Maritime  Health 
Regulations,  and  the  elementary  principles  of  morality,  for  the  sake  of  com- 
mercial interests. 

yalparaiso,  the  commercial  emporium  of  the  Republic,  was  compelled  to  take 
stringent  prophylactic  measures  in  order  to  stamp  out  the  scourge.  The  Superior 
Council  of  Public  Health  and  the  Departmental  Council  of  Valparaiso  sug- 
gested to  the  authorities  the  necessary  emergency  measures  that  were  taken. 

Arica  and  Tacna. — In  1904,  these  two  ports  were  also  visited  by  the  plague, 
a  few  cases  being  recorded.  In  October  and  November,  28  cases,  with  9 
deaths,  occurred  in  Arica,  and  in  Tacna,  from  December,  1904,  to  March,  1905, 
9  cases  with  6  deaths. 

Pisagua. — The  Chilean  town  that  has  suffered  most  on  account  of  the  plague 
is  that  of  Pisagua,  north  of  Iquique,  and  it  is  the  northernmost  nitrate  port  of 
Chile.  It  has  a  population  of  from  3,000  to  4,000  inhabitants,  varying  in  accord- 
ance with  the  increase  or  decrease  of  commercial  exports.  In  order  to  estimate 
the  seriousness  of  these  exotic  invasions,  it  must  be  taken  into  consideration 
that  from  Pisagua,  situated  at  19°  34'  south  latitude  and  70°  n'  west  longitude, 
to  Taltal,  situated  at  25°  25'  south  latitude  and  70°  34'  west  longitude — which 
is  the  zone  ordinarily  threatened  by  the  scourge — there  is  a  population  of 
150,000  inhabitants,  exporting  annually  30,000,000  quintals  of  nitrate  (i  quintal= 
loo  pounds)  ;  this  region  produces,  besides,  a  great  amount  of  minerals  and 
salts  of  various  kinds.  In  this  zone  are  included,  from  south  to  north,  the 
ports  of  Taltal,  Antofagasta,  Mejillones,  Tocopilla,  Iquique,  Pisagua,  Coloso, 
Caleta  Buena,  and  Junin. 

The  first  invasion  of  bubonic  plague  in  the  Port  of  Pisagua  took  place 
in  the  year  1905,  and  caused  310  cases  in  two  months.  The  rapidity  with  which 
the  epidemic  spread  out,  and  the  violence  of  the  attack  caused  a  great  panic 
among  the  inhabitants,  who  abandoned  their  homes  in  large  masses.  This 
migration  left  the  city  with  only  the  local,  military,  and  sanitary  authorities. 
The  inhabitants  took  refuge  in  the  plains,  where  the  infection  has  never  pene- 
trated. The  following  table  shows  the  movement  of  this  epidemic: 


142  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Statistical  Resume  of  the  Epidemic  of  Bubonic  Plague  in  Pisagua,  from  January 
27,  1905,  to  March  31,  1905: 

Total  number  of  cases 308 

Deaths 72,  or  23.37%. 

The  total  number  of  cases  is  distributed  between  the  two  sexes  as  follows; 

Men 199  with  44  deaths   (22.11%) 

Women 109  with  28  deaths   (25.68%) 

The  distribution  by  ages  is  as  follows: 

From  21  to  30  years .36.36% 

From  31  to  40  years 15.90% 

From  51  to  60  years 13.63% 

Under    10   years 11.36% 

From  ii  to  20  years 9.09% 

From  41  to  50  years 

Over  61   years 2.27% 

The  number  of  cases  treated  in  the  lazaretto  was 281 

Treated  in  private  houses 27 

Total 308 

In  this  resume  are  not  included  two  plague-stricken  bodies  that  were  found 
in  private  houses. 
Distribution  by  nationalities: 

Chileans 196  or  63.63% 

Peruvians    72  or  23.37% 

Bolivians 26  or    8.44% 

Asiatics 7  or    2.27% 

Italians 2  or      .64% 

Spaniards I  or      .32% 

Portuguese   I  or      .32% 

Austrians I  or      .32% 

Unknown 2  or      .64% 

Valparaiso  and  Vina  del  Mar, — The  plague  made  its  reappearance  in  1906, 
causing  23  victims  in  the  latter  city,  and  a  few  isolated  cases  in  the  former. 

The  Superior  Council  of  Hygiene  sent  a  sanitary  inspector,  who,  with  the 
consent  of  the  local  authorities  and  the  Departmental  Council  of  Valparaiso,  was 
able  to  enforce  prophylactic  measures  and  to  quench  the  disease  in  its  incipiency. 

At  the  same  time,  in  the  northern  section  of  the  country,  new  isolated  cases 
had  appeared,  in  this  instance  with  greater  tenacity  than  in  the  Port  of  Taltal, 
taking  the  proportions  of  an  epidemic  in  the  early  part  of  the  current  year,  to 
such  an  extent  that  the  presence  of  the  Director  of  the  Institute  of  Hygiene 
was  required.  This  officer  brought  with  him  the  necessary  elements  to  organize 
the  defense  and  to  establish  a  Bureau  of  Hygiene. 

Santiago. — In  January  of  the  present  year,  the  Asiatic  plague  made  its 
appearance  in  our  capital. 

The  Superior  Council  of  Public  Health  and  the  Institute  of  Hygiene  were 
ready  for  the  defense  from  the  beginning;  their  sanitary  inspectors  were  duly 
authorized  to  proceed  with  the  work.  The  Supreme  Government  created  a 
Central  Sanitary  Board  composed  of  the  Intendente  of  the  province,  the  First 
Alcalde  (Mayor)  of  the  city  and  the  President  of  the  Superior  Council  of 
Health,  and  assisted  by  the  sanitary  inspectors  for  the  enforcement  of  its  reso- 
lutions. Although  the  Law  of  Sanitary  Police  was  not  put  in  force,  which 
law  authorizes  the  adoption  of  extraordinary  measures  in  these  cases,  this 
Board  took,  however,  energetic  and  stringent  measures  of  prevention,  which, 
if  they  had  been  termed  as  "dictatorial"  by  the  press  adverse  to  such  actions, 
were,  nevertheless,  crowned  with  success,  inasmuch  as  the  infection  was  checked 
and  the  number  of  cases  reduced.  Only  24  were  recorded  during  the  period 
from  January  to  April,  1907.  These  cases  did  not  constitute  a  focus,  and  it  is 
interesting  to  note  that  they  were  scattered  throughout  the  city,  as  may  be 
seen  in  the  accompanying  map  (Annex  II).  • 

First  Half  of  1907.— During  this  period  the  plague  reappeared  in  the  northern 
part  of  the  Republic.  The  statistics,  which  are  given  in  detail  in  another  section 
of  this  report,  show  a  total  of  695  cases  with  302  deaths,  or  43  per  cent  of 
mortality. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  143 

The  commonest  clinic  form  of  the  plague  is  the  bubonic  form  proper  in  75 
per  cent  of  the  cases.  The  order  of  the  inflammation  of  the  ganglions  has  been 
manifested  as  follows :  Ganglions  of  the  right  and  of  the  left  inguens ;  of  the 
crural  and  inguinal  regions ;  of  both  inguens ;  of  the  neck ;  of  the  axillas,  and  of 
combined  regions.  The  septicemic  or  intestinal  form  was  presented  in  5  or  6 
per  cent  of  the  cases ;  the  pneumonic  form  in  i  or  2  per  cent,  and  the  rest  of  the 
cases  were  mild  or  ambulatory.  In  Annex  III  is  given  a  table  containing  the 
statistics  referred  to  above,  and  which  was  furnished  us  by  Dr.  R.  Davila  Boza, 
Director  of  the  Institute  of  Hygiene  at  Santiago. 
Yellow  fever,  cholera,  malaria,  beri-beri,  and  trachoma. — As  we  have  already 

stated,  yellow  fever  does  not  exist  in  Chile. 

In  1868,  the  year  in  which  the  great  invasion  of  this  disease  took  place  in 
Callao  and  Lima,  it  spread  to  Tacna,  Arica,  and  Iquique  in  Chile,  but  in  a  milder 
form.  Twelve  patients  from  the  north  took  refuge  in  Valparaiso,  but  they 
were  cured  and  did  nothing  but  cause  alarm  and  panic. 

In  1904,  three  yellow  fever  patients  arrived  in  Punta  Arenas  by  the  S.  S. 
"Oropesa"  from  Rio  de  Janeiro.  This  steamer  left  said  port  on  the  23d  of 
April;  the  first  case  occurred  four  days  thereafter,  and  the  next  two,  two 
days  later.  One  of  the  patients  died.  The  "Oropesa"  did  not  accept  the 
quarantine  imposed  on  her  and  left  for  Coronel,  where  she  again  refused  to  be 
subjected  to  quarantine,  and,  sailing  for  Valparaiso,  arrived  at  that  port  on  the 
9th  day  of  May. 

It  seems,  therefore,  that  our  country,  which  has  always  remained  immune 
from  the  infections  caused  by  the  Stegomya  Fasciata,  is  not  a  field  for  yellow 
fever. 

In  1906  the  S.  S.  "Luxor,"  of  the  Kosmos  Line,  arrived  from  Callao  infected 
with  yellow  fever.  This  steamer  started  from  Guayaquil,  had  a  crew  of  61 
members,  carried  2  first-class  and  6  second-class  passengers;  the  number  of 
cases  that  occurred  during  the  trip  was  five,  three  of  which  died. 

This  steamer  was  fumigated  in  Callao;  the  bilge  water  was  bacteriologically 
examined,  and  the  provision  was  changed ;  all  living  plants  on  the  steamer  were 
thrown  overboard,  but  in  spite  of  all  these  measures,  the  disease  still  continued. 
In  view  thereof,  she  was  ordered  on  the  nth  of  April  to  sail  for  the  south 
without  touching  any  port  of  the  Peruvian  coast.  On  April  i$th  she  arrived 
in  Arica  where  she  was  disinfected  and  subjected  to  quarantine  until  the  i8th 
day  of  the  same  month,  far  from  the  coast;  the  members  of  the  crew  and  the 
passengers  were  inspected  daily. 

No  new  cases  occurred,  and  the  steamer  was,  therefore,  given  free  pratique. 

Malaria  is  unknown  in  the  country.  Beri-beri  is  likewise  unknown.  In  Au- 
gust of  1904,  the  ship  "Talborg,"  from  the  Fiji  Islands,  was  stranded  on  the 
coast  of  Itata,  Southern  Chile,  having  on  board  some  patients  who  were 
considered  by  the  local  authorities  as  cases  of  bubonic  plague.  A  sanitary  in- 
spector of  the  Superior  Council  found  that  they  were  cases  of  beri-beri.  The 
entire  crew  perished  on  account  of  the  small  epidemic,  except  two  of  its  mem- 
bers, the  cook  and  a  young  boy. 

Trachoma  was  imported  in  1892  by  Spanish  immigrants.  The  diagnosis  was 
made  by  Doctor  Maximo  Cienfuegos,  Professor  of  Ophthalmology,  who  in- 
formed the  Government  of  the  dangers  which  this  new  disease  could  bring 
to  the  country. 

Arabian  and  Turkish  immigrants  imported  new  cases  of  granulous  conjuncti- 
vitis.    In  a  statistical  table  of  the  ophthalmological  clinic,  it  is  shown  that  tra- 
choma is  credit  with  only  0.14  per  cent  in  17,000  known  cases  of  various  forms 
of  conjunctivitis. 
Other  infectious  diseases;  small  pox ;  vaccination.. 

Smallpox  is  the  scourge  that  in  other  times  made  the  greatest  number  of 
victims  in  Chilean  territory. 

Its  history  covers  many  gloomy  pages.  The  disease  made  its  first  appearance 
in  Chile  in  the  year  1561,  imported  by  the  ships  of  Governor  Don  Francisco 
de  Villagra.  Natives  and  conquerors  alike,  by  thousands,  paid  their  tribute 
to  this  scourge.  Inoculation,  or  the  method  of  provoking  a  similar  but  milder 
disease  by  means  of  the  introduction  into  the  dermis  of  the  smallpox  pus,  dim- 
inished the  damages  caused  by  the  epidemic.  This  system  was  first  used  in 
Chile  in  the  latter  part  of  the  XVIII  century  by  Father  Pedro  Manuel  Chaparro, 
a  creole  and  eminent  physician,  who  as  has  been  verified  in  our  historic  archives,  was 
ignorant  of  the  fact  that  the  use  of  this  therapeutic  process  had  been  general 


144  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

in  Europe  since  1717,  due  to  the  initiative  of  Lady  Wortly,  through  a  fortunate 
coincidence  known  in  the  history  of  medicine.  Some  years  later,  this  same 
physician  was  the  first  one  that  utilized  Jenner's  discovery,  making  the  first 
vaccination  in  1805,  with  vaccine  sent  to  Chile  by  the  Viceroy  of  Plata. 

In  the  brief  synopsis  of  the  history  of  smallpox  in  Chile,  mention  should 
be  made  of  the  work  done  by  the  Spanish  physician  Don  Francisco  Javier  Balmis, 
who  was  sent  by  King  Charles  IV,  in  the  beginning  of  the  last  century,  to 
spread  throughout  the  new  world  the  benefits  of  vaccination,  and  whose  expedi- 
tion, started  in  1803,  rendered  so  noble  services  over  almost  the  entire  American 
continent,  particularly  in  this  beautiful  land  of  New  Spain,  the  flora  and  fauna  of 
which  he  described  in  1794. 

In  Chile,  Manuel  Julian  Grajales,  one  of  the  assistant  physicians  of  the 
Balmis  expedition,  was  the  apostle  of  the  vaccination  propaganda. 

This  was  the  commencement  of  the  fight  against  smallpox,  a  fight  that  has 
not  yet  been  ended  because  we  have  not  been  able  to  overcome  the  opposition, 
of  a  political  nature,  rather  than  social,  presented  against  the  passage  of  the 
bill  establishing  compulsory  vaccination  in  the  Republic. 

However,  it  seems  that  this  time  the  force  of  public  opinion  will  overpower 
that  opposition,  and  this  bill,  which  is  now  before  the  House  of  Deputies,  will 
become  a  law  of  the  Republic  within  a  few  more  months. 

In  order  to  counteract  this  omission,  the  Central  Board  of  Vaccination,  by 
authority  of  regulations  issued  by  the  Executive,  propagates  its  benefits  through- 
out the  country,  assisted  by  the  Departmental  boards,  vaccination  physicians, 
medical  inspectors,  and  a  numerous  corps  of  graduated  vaccinators. 

The  voluntary  submission  to  vaccination,  the  propaganda  by  means  of  the 
press,  circulars,  the  clergy,  and  by  persuasion,  principally  in  fields  and  homes, 
and  partially  compulsory  vaccination  in  schools,  in  the  army  and  navy,  in  prisons, 
etc.,  fill  to  a  certain  extent  the  action  expected  from  the  bill  in  question. 

To  this  propaganda,  as  well  as  to  the  fear  of  a  serious  recrudescence  of  the 
epidemic  in  Valparaiso,  was  due  that  the  number  of  persons  vaccinated  in  the 
country  during  1905,  reached  a  total  of  590,386,  an  increase  of  100,600  over  1904; 
this  total  is  distributed  as  follows:  New  vaccinations,  262.145;  revaccinations^ 
328,241. 

Animal  vaccine  is  the  one  preferred  by  the  public ;  in  1905,  567,964  vaccina- 
tions were  made  with  it,  and  only  22,422  were  vaccinations  from  arm  to  arm. 

Of  the  total  vaccinations  made  in  1905,  28,023  were  children  under  one  year 
of  age,  an  amount  which  represents  only  one-fourth  of  the  nativity  in  the  coun- 
try, as  the  number  of  births  in  Chile  correspond  to  40  per  thousand  of  its 
population. 

The  following  is  a  resume  of  the  movement  of  the  last  invasion : 

In  1902,  the  first  smallpox  cases  that  infected  the  littoral  from  Ascotan  to 
Calama  and  Antofagasta,  were  imported  from  the  Bolivian  frontier,  24  deaths 
having  been  recorded  in  a  period  of  four  months. 

In  1903,  the  disease  spread  through  the  plains  of  Tarapaca,  towards  the 
south,  and  caused  389  deaths,  recorded  in  the  civil  register. 

In  1904  and  1905,  the  epidemic  reached  its  algid  period:  In  Tarapaca  it 
caused  253  cases  with  96  deaths;  in  Talca,  253  cases  with  151  deaths,  and 
several  cases  and  deaths  in  several  towns  with  smaller  foci,  such  as  Tacna, 
Arica,  Copiapo,  Coquimbo,  Ovalle,  Rancagua,  Curico,  and  San  Fernando.  In 
1904  Santiago  had  1,551  known  cases,  of  which  1,475  were  treated  in  the 
lazaretto,  with  792  deaths,  or  a  mortality  of  53.6  per  cent.  A  salient  feature 
is  the  fact  that  the  deaths  take  place  always  among  those  that  have  not  been 
vaccinated.  For  instance,  in  the  last  epidemic  at  Talca,  of  253  cases,  234  were 
of  non-vaccinated  persons,  and  19  of  persons  that  had  been  vaccinated  over  ten 
years  previous;  the  entire  total  of  151  deaths,  was  of  persons  that  had  not 
been  vaccinated.  This  proportion  is  shown  in  all  statistics  of  smallpox  epidemics. 
This  is  the  strongest  argument  that  can  be  adduced  in  support  of  the  cause  of 
compulsory  vaccination. 

In  1905,  Valparaiso  was  violently  attacked  by  an  epidemic  of  smallpox.  First, 
87  cases  with  34  deaths  occurred  in  1904;  the  epidemic  continued  its  march 
slowly  until  January,  1905,  and,  taking  violent  proportions  in  May  and  June 
of  the  same  year,  it  caused  3427  cases  in  July,  and  3434  in  August;  the  number 
of  cases  in  September  was  reduced  to  1,079,  and  in  October  to  217. 

In  order  to  stamp  out  this  epidemic,  it  was  necessary  to  put  in  force  the 
most  energetic  measures. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  145 

The  civil  and  local  authorities,  the  Board  of  Residents  specially  organized  for 
this  purpose,  the  Fire  Department,  and  all  the  residents  of  the  city,  rendered 
valuable  assistance  to  the  medical  profession  and  to  the  Board  of  Vaccination. 
The  School  of  Medicine  of  Santiago  closed  its  sessions,  and  the  professors, 
together  with  the  students,  went  to  render  their  services  without  any  compensa- 
tion in  the  lazarettos,  hospitals,  an<l  homes,  and  to  help  in  the  work  of  vaccina- 
tion. The  people  were  at  first  opposed  to  vaccination,  but  they  finally  submitted. 
The  Government  was  placed  under  the  necessity  of  putting  in  force  the  Law 
of  Sanitary  Police  in  order  to  be  empowered  with  extraordinary  faculties. 

The  great  number  of  vaccinations  made  exhausted  the  supply  of  vaccine  virus, 
and  it  was  necessary  to  order  it  by  cable  from  the  Argentine,  Bolivia,  Peru  and 
Switzerland,  which  nations  nobly  hastened  to  help  us. 

The  number  of  vaccinations  during  that  year  was  116,640,  and  in  the  entire 
Republic,  567,964.  The  number  of  cases  of  smallpox  in  that  port  reached  the 
sum  of  10,953,  with  4,948  deaths. 

In  Santiago,  there  were  in  the  lazaretto  1,628  cases,  of  which  807  died.  The 
number  of  cases  that  occurred  in  Antofagasta  was  1,079.  The  epidemic  caused 
9,563  deaths  in  the  whole  Republic. 

Fifty  per  cent  of  the^  patients  were  from  20  to  60  years  of  age;  25  per  cent 
from  one  to  five  years. 

The  confluent  and  hemorrhagic  forms  of  smallpox  are  always  observed  in 
non-vaccinated  patients,  and  are  responsible  for  the  total  number  of  deaths. 
The  mild  form  saved  always  the  vaccinated  persons.  These  are  classic  and 
incontestable  facts  shown  in  our  statistics. 

Scarlet  fever,  diphtheria,  and  typhoid  fever. — According  to  the  "Boletin  de 
Higiene  y  Demografia,"  Santiago  had  the  following  cases  of  these  diseases  dur- 
ing the  years  specified : 

1901 — Scarlet  fever — i  case;  diphtheria  or  croup,  112. 
1902 — Scarlet  fever — 2  cases;  diphtheria  or  croup,  137. 
1903 — Scarlet  fever — o  cases;  diphtheria  or  croup,  39. 

The  distribution  of  the  anti-diphtheric  serum,  manufactured  by  the  Institute  of 
Hygiene,  among  the  physicians  of  the  capital,  and  the  Intendentes  and  Gover^ 
nors,  for  free  distribution  upon  medical  prescription,  was  as  follows  during  the 
years  specified: 

1899 — 1,129  vials  of  0.20  cubic  centimeters. 
1900 —  . . .  vials  of  0.20  cubic  centimeters. 
1901 — 2,575  vials  of  0.20  cubic  centimeters. 
1902 — 2,192  vials  of  0.20  cubic  centimeters. 
1903 — 1,795  vials  of  0.20  cubic  centimeters. 
1904 — 1,615  vials  of  0.20  cubic  centimeters. 
1005 — 1,427  vials  of  0.20  cubic  centimeters. 
Typhoid  fever  is  an  endemic  disease. 

The  table  given  in  another  part  of  this  report,  prepared  by  the  statistical 
division  of  the  Institute  of  Hygiene,  shows  the  mortality  caused  by  typhoid  fever 
from  1899  to  1905,  in  relation  with  the  general  mortality  (Annex  IV). 

Exanthematic  typhus,  which  appeared  in  an  epidemic  form  in  1862,  had  not 
reappeared  in  Chile.  A  few  mild  cases  occurred  in  August  of  the  current  year 
in  Valparaiso,  but  they  were  isolated.1 

PROPHYLAXIS  OF  TUBERCULOSIS  IN  CHILE. 

The  enormous  development  that  tuberculosis  has  taken  in  our  country  has 
been  a  source  of  worry  to  the  Chilean  Society  and  Government.  In  1901,  the 
Demographic  Bulletin  of  the  Institute  of  Hygiene  showed  a  mortality  of  42.9 
per  cent  in  regard  to  tuberculosis  among  the  deceased  between  the  ages  of  ten 
and  sixty.  Some  leagues  against  tuberculosis  have  been  founded,  which  distrib- 
ute prophylactic  pamphlets,  post  notices  in  the  streets  advising  the  people  not  to 
expectorate  in  the  thoroughfare,  and  establish  maritime  sanitariums  and  dis- 
pensaries. 

Hygienists  and  men  of  science  are  exerting  all  efforts  in  order  to  establish 

iWe  enclose  with  this  report  a  sanitary  map  of  Santiago,  with  annotations  of  all  cases 
of  infectious  diseases  occurring  in  1906,  and  which  were  disinfected  by  the  Public  Disin- 
fecting Station.  The  colors  of  the  annotation  correspond  with  those  of  the  international 
agreement,  in  the  following  manner:  Yellow  for  small-pox,  red  for  tuberculosis,  green  for 
typhus,  purple  for  diphtheria,  and  brown  for  several  causes. 


146  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

in  the  country  three  kinds  of  sanitariums  for  consumptives,  according  to  the 
climate  classification  that  experience  has  recently  demonstrated,  to  wit:  High- 
land, Lowland,  and  Maritime  Sanitariums. 

A  fact  that  is  worthy  of  note  is  that  the  Chilean  Indians  cannot  bear  the  ben- 
efit of  civilization. 

The  religious  order  of  the  Saletians  established  in  Puinta  Arenas,  gathered 
during  the  last  years  of  the  past  century  four  hundred  Patagonian  Indians,  who 
belong  to  a  robust  and  well  developed  race,  for  the  purpose  of  civilizing  them; 
but  at  the  end  of  seven  years  only  thirty  of  them  were  left,  all  the  others  were 
victims  of  consumption.  A  short  while  after  they  entered  the  Institution  most 
of  them  were  attacked  with  galloping  consumption.  Those  that  escaped  from 
the  disease  owed  their  lives  to  the  fact  that  they  were  allowed  to  return  to  the 
life  to  which  they  had  been  accustomed,  to  walk  barefooted  and  to  cast  away 
all  other  hindrances  that  they  had  been  compelled  to  wear  in  accordance  with 
the  requirements  of  civilization. 

At  the  present  time  consumptives  take  refuge  in  certain  points  which  have  a 
quiet  reputation  for  the  treatment  of  their  ailment,  but  which  have  really  become 
foci  of  infection  for  tuberculosis. 

The  municipal  authorities  at  those  points  have  been  alarmed  by  such  conditions 
and  in  one  of  them,  Quilque,  they  have  anticipated  their  measures  to  those  of 
the  Central  Government  by  compelling  physicians  to  report  all  cases  of  con- 
sumption to  the  local  authorities,  in  order  to  disinfect  the  houses  where  con- 
sumptives have  died  or  from  which  they  have  been  removed. 

The  Superior  Council  of  Hygiene  in  its  session  of  April  3,  1902,  resolved,  on 
motion  of  Doctor  Carvallo,  to  request  the  Minister  of  the  Interior  to  suggest 
to  Congress  the  amendment  of  the  law  of  February  7,  1899,  to  the  end  of  in- 
cluding pulmonary  tuberculosis  among  the  diseases  that  physicians  are  compelled 
to  report. 

By  virtue  of  Section  I  of  the  Municipal  Ordinance  of  Santiago  of  July  12, 
1899,  disinfection  is  compulsory  under  penalty  of  forty  pesos  in  all  cases  of 
smallpox,  scarlet  fever,  diphtheria  and  typhoid  fever,  and,  besides,  in  cases  of 
tuberculosis  when  the  patient  is  in  public  or  private  institutions,  such  as  colleges, 
hotels,  boarding  houses,  houses  of  prostitution,  etc.  (Annex  F.  4). 

In  some  branches  of  the  Government  the  prophylaxis  of  tuberculosis  is  more 
or  less  well  attended,  as,  for  instance,  in  the  Government  Railroad  where  the 
service  is  in  charge  of  the  distinguished  physician,  Sr.  Eduardo  Garcia  Collao. 
Annex  I  shows  that  the  disinfection  division  of  the  Santiago  station  composed  of 
a  majordomo  and  twelve  disinfectors,  attend  to  the  daily  disinfection  of  the 
baggage  of  all  passengers  arriving  at  the  capitol,  which  is  done  by  the  Morrison 
apparatus  with  a  solution  of  formalin  at  5  per  cent  in  the  interior  of  the  freight 
cars  after  having  been  hermetically  closed.  When  it  is  known  that  a  passenger 
suffering  from  an  infectious  disease  has  travelled  in  the  Government  lines, 
especially  if  there  be  traces  of  his  presence,  such  as  sputum,  blood,  etc.,  the  cars 
are  disinfected  in  the  manner  above  stated  and  besides  thoroughly  scrubbed  and 
washed  with  a  solution  of  corrosive  sublimate.  We  will  soon  have  in  operation 
machinery  for  the  disinfection  by  steam  of  sleeping  cars,  and  also  for  live 
stock  cars. 

On  the  other  hand,  prophylaxis  of  tuberculosis  is  neglected  in  some  institutions, 
the  public  schools,  for  instance.  It  occurs  frequently  that  school  teachers  suffer 
from  consumption.  These  unfortunate  persons  whose  salaries  are  very  limited, 
depriving  themselves  of  many  necessities  of  life,  and  the  majority  of  whom  have 
to  work  excessively  in  order  to  make  both  ends  meet,  are  compulsory  victims 
of  tuberculosis.  It  is  in  these  cases  that  the  affection  of  the  larynx  is  observed. 
These  consumptive  teachers,  who  in  order  to  make  themselves  audible  to  their 
pupils,  have  to  get  close  to  them,  constitute  a  real  danger  for  the  children  who 
become  infected  by  respiration.  In  order  to  overcome  this  great  danger  to  the 
country  the  condition  of  those  consumptive  teachers  should  be  ameliorated,  either 
exempting  them  from  service  with  full  pay  during  the  time  of  their  sickness 
or  discharging  them  definitely. 

Annex  K.  2  shows  the  statistics  of  mortality  by  tuberculosis  compared  with  the 
other  causes  of  death  in  the  principal  cities  of  the  Republic,  and  which  gave  an 
average  of  15.7  per  cent  for  1899  and  144  per  cent  for  1905. 

It  is  true  that  the  tuberculosis  mortality  shown  in  that  table  is  lower,  but  it 
should  be  borne  in  mind  that  consumptives  are  not  admitted  in  our  hospitals,  and 
in  many  cases  the  families  of  those  dying  from  the  disease  give  other  causes  of 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  147 

death  in  order  to  deceive  the  authorities.  Santiago  has  an  asylum  for  consump- 
tives, and  the  San  Jose  Hospital  to  which  are  removed  such  consumptives  as  are 
found  in  other  hospitals  and  also  those  which  apply  for  admission  therein,  the 
latter  ones  are  few,  however,  for  the  reason  that  the  people  are  prejudiced  against 
it,  and  only  recur  to  it  in  the  more  advanced  stages  of  the  disease. 

PRACTICAL  MEASURES  TO  PREVENT  THE  INFECTION  FROM  CONSUMPTIVES  TRAVELLING 
TOGETHER  WITH  WELL  PERSONS  EITHER  BY  RAIL  OR  WATER. 

Compared  with  other  diseases,  tuberculosis  is  not  easily  transmitted;  while  a 
transmitory  connection  is  needed  for  the  transmission  of  syphilis  and  gonorrhea, 
a  persistent  infection  is  necessary  for  that  of  tuberculosis.  We  all  know  the 
experiments  that  Grancher  and  Potian  used  to  make  with  the  nasal  mucus  of 
their  alumni  after  their  lectures  in  the  hospital,  rinding  in  many  cases  the  pres- 
ence of  Koch  bacillus,  which  before  the  lectures  were  absent. 

Generally,  the  presence  of  a  person  in  the  railroad  cars  is  too  short  to  enable 
him  to  contract  the  disease,  for  which  reason  we  are  of  the  opinion  that  it  would 
be  sufficient  to  follow  the  same  practice  in  force  in  many  countries  of  Europe 
and  of  the  United  States,  and  that  has  been  established  in  our  Republic  with  sat- 
isfactory results  by  the  director  of  the  service,  which  is  the  daily  disinfection 
of  the  passengers'  baggage,  as  well  as  of  the  berths  that  have  been  used ;  it  would 
also  be  advisable  to  do  away,  as  far  as  possible,  with  rugs  and  curtains.  The 
cars  should  be  provided  with  numerous  cuspidors  properly  distributed. 

If  the  above  measures  are  prescribed  for  railroads  they  are  more  necessary 
for  steamers.  The  latter  should  be  provided  with  a  Geneste-Herschell  apparatus 
for  the  disinfection  of  berths  by  steam,  and  all  cabins  should  be  washed  with 
antiseptic  solutions.  In  the  dining  rooms  the  same  methods  followed  in  sanita- 
riums for  consumptives  should  be  observed,  to  wit:  Sterilization  of  forks, 
knives,  plates,  etc.,  after  having  been  used ;  napkins  used  by  consumptives  should 
be  adequately  wrapped  so  as  to  prevent  them  from  coming  into  contact  with  the 
others.  There  should  be  cuspidors  in  the  rooms,  passageways,  etc.,  of  the 
steamer. 

Finally,  a  fine  should  be  imposed,  as  is  done  in  Sydney,  Australia,  upon  those 
who  expectorate  in  public  places. 

WATER  SUPPLY. 

The  State  supports  especially  the  Water  Services  of  the  Republic. 

The  office  of  Water  Inspection  and  Sanitation,  studies  and  orders  the  execu- 
tion of  all  the  technical  works  required  by  the  need  of  the  people. 

The  Fiscal  Administrations  of  the  Water  Enterprises  or  the  Municipalities, 
supported  by  the  State,  are  in  charge  of  these  public  services.  In  the  city  of 
Santiago  the  sources  of  water  supply  are  the  water-falls  of  Ramon  and  Vitacura, 
located  east  of  the  city,  the  former  having  its  origin  in  the  chain  of  mountains 
and  the  latter  from  nitrations  of  the  Mapocho  River,  located  at  a  distance  of 
4  and  8  kilometers,  respectively,  of  the  city  of  Santiago.  From  these  sources 
are  drawn  an  average  annual  supply  of  72,040  m3  daily,  with  a  maximum  of 
118,910  m3,  and  a  minimum  of  37,280  m3.  Additional  works  and  water  conduits 
now  in  construction,  shall  increase  within  two  years  the  water  supply  of 
Vitacura  to  91,928  m3  daily. 

The  Ramon  Creek  has  a  variable  supply,  for  the  average  annual  production 
has  been  01  111,722  m3  daily;  its  monthly  maximum  being  of  180,300  m3,  and  a 
daily  supply  of  251,860  in3,  and  a  monthly  minimum  of  56,683  m3,  and  a  daily 
supply  of  54,800  m3. 

The  average  consumption  of  drinking  water  in  Santiago,  in  1905,  was  of 
40,300  m3,  corresponding  to  a  monthly  maximum  of  46,930  m3,  and  daily  of 
51,120  m3,  and  to  a  monthly  minimum  of  33,900  m3,  and  a  daily  of  30,448  m8, 
or,  that  is  to  say,  in  the  neighborhood  of  100  liters  a  day  per  capita. 

In  view  of  the  further  needs  of  drinking  water,  required  by  the  progress  of 
the  capital,  and  by  future  requirements  of  the  sewer  system,  the  Supreme  Gov- 
ernment appointed  three  university  professors  to  report  in  regard  to  the  future 
needs  of  the  capital,  which,  according  to  the  opinion  of  the  Department  of  the 
Interior,  should  be  at  the  rate  of  300  liters  a  day  of  drinking  water  per  capita. 

This  Commission,  in  a  brilliant  report  that  we  have  the  honor  to  submit, 
as  it  contains  valuable  and  interesting  information  regarding  these  services! 


148  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

agreed,  after  having  examined  the  works  of  Freeman,  on  drinking  water  in 
New  York,  those  of  Beechman  on  Paris,  and  those  of  the  engineers  that  directed 
the  works  in  Boston,  Philadelphia  and  Cincinnati,  that  the  distribution  of  water 
for  a  city  like  Santiago  should  have  a  minimum  of  500  liters  a  day  per  capita, 
which  would  give  a  supply  of  200,000  m3  for  a  population  estimated  at  400,000 
inhabitants.  This  amount  of  water  could  easily  be  drawn  from  the  hydrographic 
basins  that  surround  Santiago,  and  still  better,  from  the  Laguna  Negra  or 
Vicuna  Mackenna,  located  in  the  heart  of  the  Andes  range  of  mountains,  for 
it  is  an  immense  and  deep  body  of  water,  having  a  surface  of  16  kilometers, 
and  being  at  an  altitude  of  2,772  meters  above  the  sea  level.  The  Laguna 
Encanada,  formed  from  filtrations  of  the  first  mentioned,  is  located  at  an  alti- 
tude of  2,572  meters,  and  could  also  be  exploited  for  the  capital's  use. 

The  quality  of  the  drinking  water  of  Santiago  is  always  satisfactory;  its 
temperature  in  the  distributing  reservoirs  is  not  higher  than  15  degrees  or 
16  degrees  centigrade.  Chemical  analysis  show  that  its  salts  are  in  a  normal 
proportion  to  be  drinking  water;  chlorine  and  ammoniac  leave  infinitesimal 
traces.  Its  classification  is  "very  good." 

The  Hygienic  Institute  of  Santiago  has  been  making  fortnightly,  since  1894, 
six  years  before  that  of  Paris,  some  bacteriological  and  chemical  analysis  of  the 
waters  on  various  samples  taken  from  the  reservoirs  and  from  the  spigots 
of  this  service  at  the  aforesaid  Hygienic  Institute. 

The  number  of  colonies  of  bacteria  has  been,  on  an  average,  of  46  per  cubic 
centimeter;  in  the  analysis  of  former  years,  maxima  of  204  have  been  observed 
in  the  summer  and  a  maximum  of  5,  in  winter,  for  the  waters  of  Vitacura. 
Those  of  Ramon  have  had  a  maximum  of  134  and  a  minimum  of  8  colonies. 

The  coli  bacillus  is  found  three  or  four  times  during  the  year  in  the  various 
fortnightly  samples.  The  waters  in  Paris,  in  all  its  samples,  show  the  presence 
of  the  coli  bacillus. 

The  Eberth  bacillus  has  not  been  found  in  the  waters  of  Santiago. 

In  Valparaiso  the  Penuelas  Lake  is  the  source  of  supply,  and  the  consumption 
for  a  population  estimated  at  150,000  inhabitants,  was  only  of  22,221  m3  of 
filtered  water  a  day  and  16,200  m8  of  unfiltered  water,  used  by  the  Electric 
Traction  Company. 

Iquique,  Antofagasta  and  Pisagua  have  private  sources  of  water  supply, 
deficient  for  the  present  needs  of  their  inhabitants. 

The  Supreme  Government  has  sent  a  message  to  Congress,  asking  the  authori- 
zation to  spend  three  million  dollars  to  supply  the  city  of  Iquique  with  splendid 
water  which  it  abundantly  possesses  in  the  falls  of  Chintaquay  and  at  the 
rate  of  160  liters  a  day  per  capita.  To-day  the  cubic  meter  of  water  costs  $10. 

In  me  annexes  relative  to  the  sewer  systems  is  found  a  description  of  the 
cities  which  will  be  benefited  with  new  services  or  improvement  of  those  now 
existing,  according  to  the  project  of  the  Executive,  that  disposes  of  ^1,500,000 
for  Sanitation  and  water  works. 

In  Annex  V  we  publish  a  note  of  the  Sanitary  Inspection  to  the  Hygienic 
Council,  in  which  all  the  cities  that  possess  drinking  water  are  enumerated; 
those  that  require  improvements,  the  works  now  under  construction,  and  those 
under  consideration.  We  also  enclose  a  chart  showing  the  distribution  of 
conduits  of  drinking  water  in  the  city  of  Santiago. 

Annex  VI  shows  in  a  table  the  general  supply  of  water,  its  origin,  system  of 
purification,  and  ration  per  day  and  per  capita,  in  liters. 

Annex  VII  is  a  memorandum  of  the  Water  Enterprise  of  Santiago,  which 
reviews  the  history,  antecedents  and  present  condition  of  the  water  service. 

SANITARY   ORGANIZATION   IN   CHILE. 
SANITARY   ORGANIZATION. 

It  is  pleasing  to  state  that  during  the  period  that  has  elapsed  since  the  last 
Sanitary  Congress,  public  sanitation  in  Chile  has  been  the  subject  of  special 
attention  on  the  part  of  our  Government,  assisted  by  the  Superior  Council  of 
Health. 

The  exotic  epidemic  of  bubonic  plague,  the  recrudescence  of  an  epidemic  of 
small-pox,  demographic  statistics  showing  high  figures  for  the  victims  of 
tuberculosis,  typhoid  fever,  etc.,  have  impelled  the  authorities  and  the  people 
of  the  country  to  unite  their  efforts  for  the  purpose  of  attaining  a  high  degree 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  149 

of  sanitation  in  our  cities  and  to  protect  ourselves  against  diseases  entirely  for- 
eign to  our  country.  Unfortunately,  an  earthquake  that,  on  the  i6th  of  August. 
1906,  caused  the  loss  of  over  two  thousand  lives,  destroyed  several  towns,  and 
occasioned  a  national  loss  of  over  300,000,000  pesos,  diverted  the  attention  of  the 
Government  from  public  health,  but  now  that  the  country  has  recovered  to  a 
certain  extent  from  so  great  a  calamity,  the  authorities  have  resumed  their 
activity  in  prosecuting  the  work  of  sanitation  with  greater  energy. 

As  stated  by  our  colleague,  Dr.  Moore,  before  the  First  Sanitary  Convention, 
we  lack  in  Chile  an  executive  board  of  public  health  charged  with  the  control 
of  the  sanitary  affairs  of  the  country.  As  constituted  at  present,  the  Superior 
Council  of  Health  is  only  an  advisory  board,  and  is  not  vested  with  the  execu- 
tive powers  which  high  corporate  bodies  of  this  character  should  have. 

But  a  reactionary  movement  has  already  been  initiated.  In  1906,  the  Govern- 
ment appointed  a  committee,  on  motion  of  the  Superior  Council  presented  by 
my  colleague,  Dr.  Soza,  composed  of  two  hygienists,  Doctors  Lucio  Cordova 
and  Mariano  Guerrero,  Secretary  and  Counsel,  respectively,  of  said  board.  This 
committee  is  entrusted  with  the  preparation  of  a  bill,  organizing  in  the  most 
perfect  form  and  in  accordance  with  the  most  modern  methods  of  hygiene,  the 
sanitary  legislation  of  the  country. 

The  committee  referred  to  visited  during  the  past  year  the  principal  nations 
of  Europe  and  the  United  States  of  America  in  order  to  make  a  careful  study 
of  their  sanitary  laws,  and  it  is  now  preparing  its  report  and  the  proposed 
law  that  will  be  submitted  to  the  consideration  of  the  National  Congress. 

Another  step  originated  by  this  reactionary  movement  was  the  Decree  of 
January  25th,  of.  the  current  year,  whereby  a  Bureau  of  Public  Health  and 
Beneficence,  under  the  Department  of  the  Interior,  was  created.  On  the  2Qth 
of  the  same  month,  the  Executive  appointed  Dr.  Luis  Astaburuaga,  Director 
of  said  Bureau.  (Annex  VIII.) 

Later  on,  the  sub-department  of  health  wanted  by  the  medical  institutions 
of  the  country,  and  for  the  creation  of  which  a  petition  has  already  been  made 
to  the  Government,  will  be  organized.  In  the  meanwhile,  efforts  are  being 
made  for  the  establishment  of  a  Department  of  Public  Health,  which  would 
be  the  most  advanced  and  commendable  step  that  a  nation  could  take  toward 
the  cause  of  sanitation. 

Judging  from  the  interest  shown  by  the  Executive,  and  from  public  opinion, 
it  may  be  assured  that  Chile  will  have  within  a  short  time  a  Sanitary  Code 
which  will  be  as  complete  as  those  of  the  nations  most  advanced  in  public  health. 

Complying,  therefore,  with  the  provisions  of  the  program,  we  will  state  in 
this  report  what  has  been  done  during  the  past  two  years  in  regard  to  sanitary 
legislation  and  methods,  adding  a  few  brief  details  on  the  present  condition  of 
the  health  service  of  the  country. 


The  Political  Constitution  of  the  Republic,  in  its  provisions  relating  to  sani- 
tation, prescribes,  in  Section  73,  that  all  public  establishments  shall  be  under 
the  supreme  supervision  of  the  President  of  the  Republic,  in  accordance  with 
the  special  ordinances  governing  them. 

Pursuant  to  Section  119,  of  the  same  Constitution,  the  municipal  governments 
are  charged  with  the  sanitation,  comfort,  embellishment,  and  recreation  of 
their  respective  cities,  as  well  as  with  the  care  of  hospitals,  orphans  and 
foundling  asylums,  penitentiaries,  houses  of  correction,  and  other  charitable  in- 
stitutions under  the  provisions  of  law. 

A  synopsis  of  the  sanitary  functions  and  duties  of  the  Central  and  the  Munici- 
pal Governments  has  been  presented  by  the  Superior  Council  of  Health  under 
the  following  paragraphs: 

"In  Chile  the  affairs  relating  to  public  health  are  entrusted  to — 

"(a)  The  Department  of  the  Interior,  and 

"(&)  The  Municipal  Governments  of  the  Republic. 

"(a)  The  Department  of  the  Interior  issues  the  sanitary  ordinances  and 
regulations  relating  to  the  sanitation  of  the  country.  In  this  respect,  the  Central 
Government  has  under  its  supervision  all  measures  for  the  eradication  of  in- 
fectious diseases,  ^and  the  land  and  maritime  international  sanitary  police. 

"For  the  adoption  of  such  public  health  measures,  as  well  as  for  the  enforce- 
ment thereof,  the  Department  is  advised  1)y  the  Superior  Council  of  Health 
and  the  Institutes  of  Hygiene,  both  operating  in  the  city  of  Santiago. 

"For   the   execution   of   these    measures    in   provinces    and    departments,    the 


I5O  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Intendentes  and  Governors,  officers  representing  the  Chief  Executive  in  their 
respective  territories,  receive  orders  and  instructions  from  the  Minister  of  the 
Interior.  They  are  advised  by  the  Departmental  Councils  of  Health.  For  the 
enforcement  of  the  provisions  of  Maritime  Sanitary  Regulations,  the  Intendentes 
and  Governors  in  maritime  districts  are  advised  by  boards  of  health,  of  which 
are  also  members  the  senior  customs  officers,  and  the  physicians  of  the  port. 

(b)  The  municipalities,  represented  by  the  First  Alcalde  (Mayor),  are  en- 
trusted with  all  matters  referring  to  the  public  health  and  sanitary  condition 
of  towns.  In  this  respect  the  local  authorities  have  under  their  supervision  the 
sanitation  of  streets,  squares,  parks,  and  other  public  places;  the  construction 
and  maintenance  of  sewers;  the  protection  of  canals  and  aqueducts;  the  supply 
and  distribution  of  water;  the  establishment  and  management  of  free  public 
bath  houses ;  the  establishment  and  management  of  public  slaughter  houses ;  the 
regulation  of  bars,  saloons,  grocery  stores,  etc.;  the  regulation  of  unhealthful 
factories  and  industries,  workshops,  stables,  and  poultry  yards;  the  encourage- 
ment of  the  construction  of  cheap  hygienic  dwellings;  the  adoption  of  measures 
for  the  prevention  or  eradication  of  epidemics;  the  organization  of  services  of 
disinfection,  etc. 

"For  the  adoption  of  these  public  measures,  the  Alcalde  is  advised  (i)  by  the 
Superior  Council  of  Health,  upon  which  all  municipalities  of  the  Republic  may 
call  for  advice;  (2)  by  the  Departmental  Councils  of  Health,  presided  over  by 
the  Intendente  or  Governor  of  the  province  or  department. 

"Some  municipalities  have  established  within  their  respective  territories  health 
bureaus,  or  chemical  laboratories." 

The  Government,  besides  the  general  supervision  which  it.  exercises  over  all 
sanitary  matters,  has,  in  case  of  an  epidemic,  the  right  to  enforce  for  a  definite 
period,  and  the  consent  of  Congress  previously  obtained,  the  Law  of  Sanitary 
Police,  passed  on  the  3Oth  of  December,  1896.  By  virtue  of  this  law,  the  Presi- 
dent is  empowered  to  close  the  maritime  and  land  ports;  to  prescribe  quaran- 
tine measures,  compulsory  disinfection  of  passengers  and  cargoes,  and  to  adopt 
such  other  measures  which  he  may  deem  necessary  for  the  eradication  of  any 
of  the  epidemics  specified  in  the  regulations.  The  General  Health  Ordinance  of 
January  10,  1887,  specifies  the  sanitary  measures  that  may  be  adopted  by  the 
authorities. 

The  General  Board  of  Sanitation,  which  was  created  to  advise  the  Govern- 
ment in  sanitary  matters,  and  to  study  and  submit  health  and  prophylactic  meas- 
ures, and  the  departmental  boards  of  sanitation,  were  abolished  on  May  23, 
1900,  and  the  Superior  Council  of  Health  was  organized  instead  thereof.  The 
provincial  councils  of  hygiene,  established  by  decree  of  January  19,  1889,  were 
also  reorganized  and  subdivided  into  the  present  Departmental  Councils  which 
have  been  operating  since  the  loth  of  December,  1892. 

The  Law  of  Navigation,  in  force  since  June  24,  1878,  and  the  Maritime  Health 
Regulations  of  February  18,  1895,  prescribe  the  measures  of  a  permanent  charac- 
ter that  should  be  taken  against  epidemics;  the  inspection  of  vessels;  the 
issuance  of  bills  of  health;  the  adoption  of  prophylactic  measures  that 
should  be  observed  before,  during  and  after  the  voyage;  quarantine  and 
examinations ;  sanitary  stations,  sanitary  tariff,  and  the  duties  pertaining  to 
sanitary  authorities.  (The  Law  of  Sanitary  Police  and  the  Maritime  Health 
Regulations  referred  to  are  contained  in  the  report  of  Dr.  Moore,  published  in 
the  Transactions  of  the  First  Sanitary  Convention  of  1902,  Annexes  C  and  K.) 

SANITARY  STATIONS. 

The  Sanitary  Station  of  Arica  was  established  in  April,  1905,  on  account  of 
epidemic  of  plague  that  invaded  the  provinces  of  the  coast  of  Peru.  Its  per- 
sonnel consists  of:  I  chief  physician,  I  assistant,  I  bacteriologist,  I  mechanic,  I 
disinfector,  I  clerk,  2  first  class  sailors,  and  2  second  class  sailors;  this  per- 
sonnel may  be  increased  when  necessary.  The  lazaretto  is  provided  with  a  steam 
launch  whereon  is  mounted  a  Clayton  apparatus  for  the  disinfection  of  vessels. 
It  is  proposed  to  have  a  land  lazaretto  built  in  the  Port  of  Arica,  for  the 
hulk  serving  as  lazaretto  has  been  condemned  recently  The  regulations  govern- 
ing the  station  have  been  approved  by  the  Superior  Council  of  Health,  but  have 
not  yet  been  promulgated  as  law  by  the  Government.  In  the  meanwhile  it  is 
governed  by  the  Maritime  Health'  Regulations,  the  instructions  from  the  Su- 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  15! 

perior  Council  of  Health,  and,  in  so  far  as  it  is  practicable,  by  the  provisions 
of  the  proposed  ordinance. 

The  fees  for  disinfection  of  vessels  vary  from  £5  to  £20  in  accordance  with 
the  tonnage  thereof. 

During  the  calendar  year  1906,  204  vessels  were  disinfected;  of  this  total,  103 
were  passenger  vessels,  and  101  freight,  and  passenger  and  freight  vessels.  77 
vessels  used  their  own  disinfecting  apparatus. 

17,022  members  of  crews,  and  8,948  passengers  were  examined  during  the  year. 

New  details  regarding  this  service,  and  international  data  of  interest,  taken 
from  the  last  report  presented  by  the  Director  of  the  Sanitary  Station  at  Arica, 
are  given  in  Annex  IX. 

SANITARY  STATION  AT  PUNTA  ARENAS. 

A  sanitary  station  was  temporarily  operated  in  this  port,  first  from  1892  to 
1893,  and  afterwards  in  1903,  on  account  of  the  apparition  of  an  epidemic  of 
cholera  in  Portugal;  it  is  intended  to  make  this  station  a  permanent  one,  like 
the  one  at  Arica. 

SANITARY  ORGANIZATION  OF  CITIES. 

The  sanitary  and  beneficence  services  of  the  towns  of  the  Republic  is  organized 
as  follows: 

A  Board  of  Beneficence  in  each  department  performs  its  respective  duties; 
in  Santiago  and  Valparaiso  it  is  composed  of  four  members  elected  by. the 
Municipality,  four  appointed  by  the  President  of  the  Republic,  and  the  directors 
of  the  charitable  institutions ;  in  the  provinces  the  number  of  elective  mem- 
bers is  reduced  to  one-half;  these  boards  have  the  interior  economic  control  of 
their  dependencies,  including  their  rents  and  the  personnel  of  employees. 

There  is  in  each  capital  of  a  province  or  department  a  City  Physician,  ap- 
pointed by  the  Municipality,  who  is  entrusted  with  the  medical  and  sanitary 
services  of  his  locality.  In  smaller  towns,  capitals  of  autonomous  communes, 
there  are  also  physicians  and  dispensaries  supported  by  the  municipalities. 

These  organizations  have  also  special  physicians,  called  "Vaccinating  Phy- 
sicians," and  "Judicial  Physicians/'  appointed  by  the  Executive,  the  former 
to  render  their  services  to  the  Vaccination  Boards,  and  the  latter  to  co-operate 
with  the  judicial  authorities. 

There  are  in  several  parts  of  the  country  physicians  of  small-pox  lazarettos, 
who  are  under  the  Central  Government. 

Permanent  lazarettos  for  bubonic  plague  exists  in  Pisagua,  Iquique,  Anto- 
fagasta,  and  Taltal. 

The  city  physicians  are  ex  officio  secretaries  of  the  departmental  councils  of 
health. 

The  port  physicians  perform  the  Huties  prescribed  by  the  maritime  health  reg- 
ulations. 

There  are  in  Chile  many  private  medical  services  maintained  by  charitable  in- 
stitutions. 

SANITATION  AT  IQUIQUE. 

The  Port  of  Iquique  has  a  sanitary  organization  which  does  high  credit  to 
the  Municipality  that  maintains  it. 

The  sanitary  service  is  attended  to  by  two  physicians  and  a  municipal  phar- 
macist. The  municipal  Chemical  Laboratory,  established  in  1895,  renders  valu- 
able services  to  the  locality.  The  Director  of  this  establishment  has  also  under 
his  charge  other  services  maintained  by  the  central  Government,  such  as  public 
and  private  disinfections,  microscopical,  bacteriological,  biological  laboratories, 
etc.,  etc.  This  laboratory  is  also  provided  with  stoves  and  apparatus  for  dis- 
infection. 

The  law  making  the  declaration  of  infectious  diseases  compulsory  is  strictly 
enforced  in  Iquique.  A  physician  was  fined  fifty  pesos  for  his  failure  to  make 
the  declaration  required  by  law.  This  case  is  cited  for  the  reason  that  it  is 
the  only  one  that  has  occurred  in  the  country. 

The  Municipal  Chemical  Laboratory  supervises,  besides,  the  sanitary  inspec- 
tions made  by  the  Municipal  Health  Commission,  which  is  composed  of  one 


152  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

chief  and  eight  inspectors,  who  examine  the  health  conditions  of  the  town, 
divided  into  eleven  commissariats;  these  inspectors  are  also  charged  with  the 
duty  of  reporting  all  cases  of  infectious  diseases  that  come  under  their  ob- 
servation, and  all  deaths  that  might  have  occurred  in  the  city  every  24  hours, 
in  order  to  enable  the  physician  entrusted  with  the  verification  of  deaths  in 
time  of  an  epidemic,  to  certify  the  causes  of  death.  The  municipality  gives 
special  attention  to  the  sanitation  and  disinfection  of  private  houses,  the  dis- 
infection of  street  cars,  public  vehicles  and  trains,  and  to  the  supervision  of 
slaughter  houses  and  houses  of  prostitution. 

All  cases  of  tuberculosis  must  be  declared  in  Iquique. 

The  Municipal  Chemical  Laboratory  furnishes  the  public,  free  of  charge,  the 
following  serums  and  vaccines:  Haffkine  anti-small-pox  vaccine;  Yersin  anti- 
plague  serum;  Yersin  anti-diptheria  serum;  tuberculin,  and  virus  against  rats. 

In  Annex  X  is  contained  a  resume  of  the  sanitary  organization  and  demo- 
graphic statistics  of  Iquique,  furnished  by  the  Director  of  the  Municipal  Chemical 
Laboratory,  Dr.  Amador  Guajardo. 

SANITATION  IN  ANTOFAGASTA  AND  TAL.TAL. 

In  Antofagasta,  the  sanitary  work  is  entrusted  to  a  Bureau  of  Health;  this 
bureau  is  provided  with  a  disinfecting  stove  and  a  Clayton  locomobile  for  dis- 
infections; it  has  under  its  charge  the  lazaretto  for  bubonic  plague  and  small- 
pox. The  regulations  governing  this  bureau  are  instructions  issued  by  the  In- 
stitute of  Hygiene,  approved  by  the  Board  of  Beneficence  and  promulgated  by 
the  Intendente  of  the  locality.  The  efficient  activity  of  this  new  institution  has 
checked  the  progress  of  typhoid  fever  and  small-pox,  which,  besides  being  en- 
demic diseases  in  that  section  of  the  country,  were  a  constant  menace  to  the 
neighboring  ports. 

In  Taltal,  on  account  of  an  epidemic  that  broke  6ut  in  the  latter  part  of  1906, 
a  Bureau  of  Health,  similar  to  that  of  Antofagasta,  was  established;  this  bureau 
however,  is  not  yet  so  well  equipped  as  that  of  A-ntofagasta. 

OTHER  CITIES. 

TALCA. — Besides  the  service  maintained  by  the  Central  Government  in  provin- 
cial capitals,  the  city  of  Talca  has  a  sanitary  organization  of  its  own,  of  which 
the  Bureau  of  Municipal  Health  Inspection  is  in.  charge;  this  office  is  com- 
posed of  a  physician  and  a  chemist,  and  has  under  its  charge  the  micro- 
scopical and  chemical  laboratory. 

CONCEPCION. — This  city  has  also  a  sanitary  service  independent  from  that  main- 
tained by  the  Government  The  inspection  of  liquids,  beverages,  food  products, 
meats,  epizpoty,  dwellings  for  laborers,  charitable  institutions,  etc.,  are  the  prin- 
cipal functions  of  large  cities  in  respect  to  sanitary  matters,  the  Central  Gov- 
ernment helping  them  in  proportion  to  their  needs. 

VALPARAISO  AND  SANTIAGO. — Sanitary  work  done  in  these  two  principal  cities 
of  Chile  by  the  Councils  of  Health,  is  worthy  of  high  praise. 

During  the  past  two  years,  sanitation,  in  all  its  aspects,  has  received  a  great 
impulse. 

The  reconstruction  of  Valparaiso  includes  sanitary  works,  in  the  city  and  the 
houses,  in  accordance  with  modern  methods  of  sanitation. 

The  public  medical  assistance  is  being  greatly  improved  from  day  to  day. 

We  have  the  honor  to  submit  to  the  Delegates  the  minutes  of  proceedings 
of  the  Departmental  Council  of  Health  of  Valparaiso,  containing  a  resume  of 
the  sanitary  conditions  of  that  commercial  metropolis,  and  a  description  of  the 
many  and  varied  labors  executed  by  the  city  on  behalf  of  public  health.  Other 
documents,  which  are  also  enclosed  herewith,  describe  the  sanitary  conditions 
in  Santiago,  the  capital  of  the  Republic,  where,  together  with  the  improvements 
made  by  the  Government,  the  Municipality  has  established  numerous  services 
such  as  that  of  municipal  medical  assistance,  with  two  physicians,  the  sanitary 
local  inspection,  the  inspection  of  liquids  and  food  products,  slaughter  houses, 
houses  of  prostitution,  etc.;  a  chemical  and  microscopical  laboratory  of  the 
first  class,  free  public  dispensaries,  ocular,  gynecological,  and  other  institutions, 
etc.,  etc. 

It  is  proposed  to  unite  all  these  services,  making  them  a  great  polyclinic  center. 

The    Revista  Chilena  de  Higiene"  (Chilean  Review  of  Hygiene),  the  "Boletin 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  153 

de  Higiene  y  Demografia"  (Bulletin  of  Hygiene  and  Demography),  and  the 
"Actas  del  Consejo  Superior  de  Higiene  Publica"  (Minutes  of  the  Superior 
Council  of  Public  Health),  accompanying  this  report,  are  the  best  evidence  of 
our  efforts  to  place  our  country  in  the  same  high  position  occupied  by  the  most 
advanced  nations,  and  contain  numerous  statistical  data  showing  the  extent  of 
our  sphere  of  sanitary  action. 

THE  SUPERIOR  COUNCIL.  OF  PUBLIC  HEALTH  AND  THE  INSTITUTE  OF  HYGIENE. 

We  will  close  this  brief  monograph  of  our  sanitary  organization,  making  a 
description  of  the  constitution  and  scope  of  work  of  the  Superior  Council  of 
Public  Health  and  the  Institute  of  Hygiene. 

The  Superior  Council  was  created  by  law  of  September  15,  1892,  together  with 
the  Institute  of  Hygiene;  both  institutions  are  under  the  control  of  the  Depart- 
ment of  the  Interior.  The  former  is  composed  of  thirteen  members,  their 
term  of  office  being  three  years.  Seven  of  them  are  appointed 
directly  by  the  President  of  the  Republic,  three  elected  by  the 
Municipality  of  Santiago,  and  three  by  the  Council  itself.  Among 
the  persons  appointed  by  the  President,  there  is  an  engineer,  an  architect,  and 
a  high  officer  of  the  national  army  or  navy.  The  Director  of  the  Institute  of 
Hygiene  and  the  chiefs  of  divisions  thereof  are  also  members,  but  have  no  right 
to  vote.  One  of  the  members  of  the  council  must  be  a  lawyer.  The  Superior 
Council  advises  the  Government  on  all  sanitary  matters,  and  it  is  its  duty  to 
study,  and  suggest  to  the  authorities,  all  questions  relating  to  the  health  of  the 
inhabitants,  in  all  the  spheres  of  action  and  to  the  fullest  extent  authorized  by 
the  Constitution  and  the  laws  of  the  Republic.  (See  Annexes  E,  F  and  G,  to 
Dr.  Moore's  report  to  the  First  Sanitary  Convention.) 

The  Institute  of  Hygiene  has  now  five  divisions,  to  wit :  Hygiene  and  Demo- 
graphy; Microscopy  and  Bacteriology,  Chemistry,  Seroterapics  and  Disinfection. 
These  last  two  divisions  were  created  by  decree  of  September  9,  1896. 

The  Division  of  Hygiene  and  Demography  publishes  the  bulletin  in  that 
name,  and  is  in  charge  of  all  matters  pertaining  to  hygiene  throughout  the 
country;  the  Chief  of  this  division  is  the  Director  of  the  Institute,  who  is  also 
the  editor  of  the  "Revista  Chilena  de  Higiene." 

The  Divisions  of  Microscopy  and  Bacteriology,  and  of  Chemistry,  make  analy- 
ses of  those  substances  the  composition  of  which  may  have  influence  on  public 
health.  The  materials  to  be  analyzed  are  those  sent  by  the  administrative 
authorities,  those  selected  by  the  office,  and  those  furnished  by  private  indi- 
viduals; it  also  makes  such  studies  as  may  be  ordered  by  the  Superior  Council 
and  the  Director  of  the  Institute. 

The  Division  of  Seroterapics  is  charged  with  the  preparation  of  the  anti- 
rabies  vaccine,  the  anti-diphtheric  serum,  and  the  Trunecek  serum.  It  was 
annexed  this  year  to  the  Institute  of  Animal  Vaccine.  The  necessary  funds  have 
been  appropriated  for  the  preparation  by  this  division  of  the  anti-plague  serum. 

The  public  Disinfecting  Station  renders  valuable  servces  to  the  city,  and 
its  chief  has  under  his  control  the  other  disinfecting  stations  operating  in  the 
country.  In  another  chapter  of  this  report,  my  colleague,  Dr.  Soza,  describes 
the  present  condition  of  these  establishments. 

SANITARY  INSPECTION  IN  THE  REPUBLIC. 

This  new  division  of  the  Superior  Council  was  created  by  law  of  September 
28,  1896.  (Annex  XI.) 

Sanitary  inspection  is  exercised  throughout  the  country;  it  investigates  un- 
healthful  influences,  supervises  the  sanitary  conditions  of  factories,  workshops, 
tenement  houses,  buildings,  and  public  places ;  it  is  the  duty  of  sanitary  inspec- 
tors to  report  to  the  Superior  Council  all  omissions  or  deficiencies  which  they 
may  find  in  any  of  the  branches  of  the  Government  in  regard  to  public  health, 
and  to  suggest  the  means  by  which  such  omissions  or  deficiencies  can  be  reme- 
died. Inspection  of  houses  in  cases  of  infectious  diseases,  for  the  purpose  of 
taking  sanitary  or  disinfecting  measures,  or  of  investigating  the  causes  of  inspec- 
tion, or  of  giving  the  dwellers  instructions  in  sanitary  measures  and  the  appli- 
cation of  special  hygienic  rules,  are  duties  which  the  sanitary  inspectors  perform 
with  great  benefit  to  the  public  in  general. 


154  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

The  tables  contained  in  Annex  XII  show  the  number  of  sanitary  declarations 
and  inspections  made  in  Santiago  during  the  year  1906. 

It  is  to  be  regretted  that  the  limited  number  of  these  inspectors — there  are 
only  two  for  the  whole  country — prevents  them  from  extending  their  functions. 
We  suppose  that  the  new  project  of  sanitary  legislation  will  increase  the  number 
of  these  inspectors,  the  lack  of  more  of  which  has  been  made  manifest  by  the 
last  epidemic. 

The  Division  of  Sanitary  Inspection  is  also  charged  with  the  preparation  of 
the  "Sanitary  Table  of  Santiago,"  a  special  register  in  which  are  recorded,  by 
blocks,  the  plans  of  each  building,  with  a  statement  of  its  sanitary  conditions, 
alterations  that  should  be  made,  conditions  around  the  neighborhood,  and  cases 
of  infectious  diseases  that  have  been  reported  to  the  Institute  of  Hygiene. 

The  Sanitary  Register  of  Santiago  is  a  work  of  great  importance  to  the  pro- 
phylaxis of  the  capital  and  which  does  credit  to  its  authors. 

Annex  XIII  contains  a  form  of  these  tables.  In  Annex  XIV  is  a  statement 
of  the  services  rendered  gratis,  and  for  compensation,  by  the  Institute  of  Hygiene, 
and  which  shows  the  work  done  by  this  institution  in  behalf  of  the  public  welfare. 

HARBOR  AND  SEWER  WORKS;  DISINFECTORIES;  DWELLINGS 
FOR  WORKINGMEN;  IMMIGRATION;  SLAUGHTERHOUSES, 
AND  SANITARY  SERVICE  OF  AN  EARTHQUAKE. 

In  methodical  pursuance  of  the  indications  contained  in  the  provisional  program 
that  served  as  a  basis  for  our  Report,  we  beg  to  refer  to  paragraph  (b)  which 
says:  "A  report  on  the  condition  of  the  ports  of  his  country,  specifying  the 
works  which  may  have  been  executed  therein,  those  in  course  of  construction 
and  those  which  are  projected,  as  well  as  the  manner  in  which  the  problem  of 
water  supply,  proper  sewerage  and  of  the  connection  of  house  drains  with  that 
system  of  sewers  has  been  resolved,  as  well  as  the  methods  that  have  been 
employed  or  are  proposed  for  the  sanitation  of  the  dwellings." 

PORTS. 

In  Chile  we  have,  in  this  respect,  ne  work  under  construction;  but  there  are 
some  projects  that  are  under  consideration  for  the  ports  of  Mejillones,  Anto- 
fagastay  Valparaiso,  Constitucion,  Coronel  and  Valdivia. 

In  annex  A  will  be  found  some  laws  and  other  data,  among  which  the  follow- 
ing will  be  observed: 

ist.  A  decree  of  April  7,  1906,  by  which  an  approval  is  made  of  the  plans 
of  the  city  plant  project  and  of  the  improvement  of  the  port  of  Mejillones,  in 
which  it  is  ordered  that  a  message  to  the  National  Congress  be  sent,  requesting 
that  the  minor  port  already  mentioned  be  raised  to  the  main  class. 

2d.  Law  No.  1835,  of  February  12,  1906,  authorizing  to  contract  a  loan  of 
(£1,500,000)  one  million  five  hundred  thousand  pounds,  sterling,  in  order  to 
carry  out  the  defense  works  of  Valparaiso,  sewer  work  of  Talca  and  Concep- 
cion  and  supply  and  improvement  of  the  water  works  of  various  cities. 

3d.  Law  No.  1816,  of  February  13,  1006,  authorizing  an  expenditure  for  the 
construction  of  improvement  works  of  the  port  of  Antofagasta. 

4th.  Decree  of  June  19,  1906,  authorizing  Messrs.  Gustavo  Ried  and  Julio 
Torrealba  for  the  construction  of  harbor  or  interior  basin  at  Constitucion. 

SEWERS. 

Their  present  condition  in  Chile  is  the  following:  Modern  Sewer  Systems  in 
Working  Order: 

Iquique. — Estimated  population  in  1905,  43,500  inhabitants.  It  has  a  network 
of  water  conduits  of  small  diameter  for  refuse  water.  The  draining  is  made 
with  sea-water,  mechanically  raised  and  distributed  through  a  special  network. 
It  never  rains  here,  which  fact,  consequently,  was  taken  into  consideration. 
(Annex  B.) 

Valparaiso. — Estimated  population  in  1905,  150,962  inhabitants.  The  separate 
system  is  employed.  The  refuse  waters  go  through  a  special  network,  and  are 
raised  mechanically  (4.50  meters)  to  empty  in  the  sea.  There  are  great  trenches, 
normal  to  the  coast,  that  collect  the  rain  water  of  the  city,  as  well  as  that  of  the 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  1 55 

mountains  surrounding  it.    Presently  more  than  three-fourths  of  the  city  is  pro- 
vided with  a  special  drainage  network,  and  the  remainder  is  contracted  for. 

SEWERS  UNDER  CONSTRUCTION. 

Santiago.— Estimated  population  in  1905,  400,000  inhabitants.  The  drainage 
project  is  based  on  the  unitary  system;  the  plan  of  the  network  has  been  designed 
in  a  zig-zag  form,  and  continuous  drainage  has  been  adopted.  The  refuse  waters 
go  by  gravitation  to  the  Mapocho  River.  The  network  has  a  total  spread  of 
304  kilometers.  The  amount  to  be  paid  as  per  contract  is  $16,785,000  gold  of 
18  pence,  of  which  amount  the  sum  of  $3,730,000  is  allotted  for  the  enlargement 
and  improvement  of  the  water  service  and  paving. 

Annex  C  shows  us  a  plan  of  the  city .  of  Santiago  with  its  sewer  and  drain- 
age system,  which,  as  it  will  be  seen,  joins  the  waters  of  the  Mapocho  River. 
In  the  sewer  system,  the  interior  dimensions  vary  from  0.30  m.  to  one  meter. 
The  concrete  collectors,  from  0.90  cm.  to  3.50  m,,  the  inferior  ones  being  ovoid 
in  shape,  for  a  length  of  about  one  meter  and  seventy-five  centimeters,  and  those 
of  larger  size  than  the  above  mentioned,  have  a  cylindrical  shape. 

It  was  the  object  of  a  careful  st'udy,  to  determine  whether  the  ovoid 
profile  should  be  placed  with  its  sharpest  end  in  the  upper  or  in  the  lower 
parts.  The  result  of  this  investigation  has  been  to  select  the  broad  side  to  be 
placed  at  the  base  and  the  thinner  on  the  top,  which  has,  among  other  things, 
the  following  advantages:  Greater  resistance,  easier  access,  and,  because  of  a 
smaller  radius,  it  is  comparable  to  that  of  the  circular  profiles,  that  precede  or 
follow  the  ovoid,  and  there  is  more  harmony  between  them. 

The  drainage  system  starts  with  a  dimension  of  one  meter  and  ends  with 
one  of  0.25  cm.  The  accepted  drainage  system  has  a  necessary  capacity  to  carry 
the  refuse  waters  of  a  population  that,  in  the  future,  it  is  supposed  will  be 
double  of  the  present ;  that  it  may  carry  a  rain  considered  as  regular  fall  at 
Santiago,  the  intensity  of  which  is  of  70  liters  per  second  and  per  hectare. 
Heavier  rainfalls,  as  an  average,  occur  once  a  year. 

Illustration  No.  9,  of  the  Annex,  shows  that  the  greatest  rainfall  under 
observation  is  that  of  June  16,  1902,  in  which  case  it  reached  an  intensity  of 
80  liters  per  second  and  per  hectare,  for  nearly  two  minutes. 

Modern  European  canalizations  are  not  constructed  with  a  capacity  to  carry 
the  heaviest  rainfalls  that  have  occurred  or  that  may  occur  in  the  future;  this 
would  lead  to  the  construction  of  gigantic  works  that  very  few  cities  could  afford 
to  carry  out,  and  no  proportional  advantages  could  be  derived  therefrom;;  if 
such  a  sewer  system  should  be  constructed  to  have  a  capacity  for  the  heaviest 
rains  recorded  in  Santiago,  many  millions  would  have  to  be  spent  to  save  the 
city  for  a  few  hours  of  a  century  of  troubles  of  less  magnitude  than  those  it 
endures  today  in  winter  time.  Due  to  many  causes;  percolation,  retention  in  the 
irregularities  of  the  soil  and  lower  planes,  existence  of  absorbing  wells,  evapora- 
tion, etc.,  etc.,  the  rain  that  reaches  the  canalization  is  less  than  the  volume  of 
the  fallen  rain  in  a  proportion  of  about  half,  as  may  be  seen  in  illustration 
No.  13  of  the  Annex. 

According  to  the  latest  Annual  Reports  of  the  Water  Enterprise,  relative  to 
the  influence  over  the  consumption,  the  improvements  of  the  drainage  network, 
and  the  establishment  of  the  sewer  system,  for  1910,  the  consumption  of  120 
liters  per  day  and  per  capita  has  been  accepted.  For  the  maximum  refuse  water 
in  the  future,  taking  place  simultaneously  as  the  maximum  rainfall,  which 
determines  the  capacity  of  the  network,  300  liters  per  day  and  per  capita  has 
been  accepted,  supposing  that  the  maximum  consumption  in  24  hours  is  double 
the  average. 

As  annex,  I  also  accompany  a  resume  of  the  final  project  relating  to  the  regu- 
lations governing  the  dwelling  installations. 

Vina  Del  Mar. — The  Illustrious  Municipality  has  contracted  with  the  firm  of 
Hughes  and  Lancaster  of  London  regarding  the  construction  of  the  city  drainage. 

SEWER  SYSTEMS,  FOR  WHICH  'Bios  HAVE  BEEN  ASKED. 

Conception. — Said  bids  are  being  considered. 

Talca. — In  March,  1908.  A  description  and  plans  may  be  examined  in  Annex  D. 

Antofagasta. — In  October,  1908. 


156  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

SEWER  SYSTEM  PRESENTLY  UNDER  CONSIDERATION. 

Of   Pisagua. 

Of  Copiapo. 

Of  Curico. 

Of  Chilian. 

As  annex  (E)  will  be  found  a  table  containing  statistical  data  showing  the 
percentage  of  deaths  due  to  tuberculosis  and  typhoid  fever  in  1900,  because  it  is 
the  year  in  which  complete  information  could  be  had  for  all  the  cities  over 
10,000  inhabitants.  In  tuberculosis  the  percentage  has  fluctuated  between  8  and 
10  per  cent  out  of  the  general  death  rate.  Regarding  typhoid  fever  the  variable 
cases  have  been  the  most  intense,  betwen  i  per  cent  at  Santiago  and  25  per 
cent  recorded  at  Chilian.  This  enormous  death  rate  was  due  to  a  great  epidemic 
which  occurred  in  that  year.  In  1904  it  was  lowered  to  2  per  cent,  but  a  new 
epidemic  in  1905  raised  the  percentage  to  21. 

In  that  table  an  observation  may  be  made  as  to  the  present  drainage  systems 
in  the  various  cities  of  that  Republic  having  a  population  of  more  than  5,000 
inhabitants.  Out  of  32  cities,  12  have  drain  trenches;  n  absorbing  wells;  2 
sewer  system,  and  i  drain  canals. 

The  construction  of  sewer  systems  has  begun  in  the  most  important  cities,  and 
where  needed  the  most,  in  such  a  way,  that  the  day  is  not  far  distant  when  all 
the  12  cities  will  have  a  complete  sewer  system. 

PUBLIC  DISINFECTORIES. 

There  are  now,  in  readiness,  to  be  distributed  to  various  cities,  9  Geneste- 
Antofagasta,  Coquimbo,  Lerena,  Valparaiso,  Santiago,  Curico,  Talca,  Chilian, 
Conception  and  Punta  Arenas. 

A  disinfectory  heater  has  also  been  delivered  to  San  Bernardo  and  another  to 
Los  Angeles,  which  will  soon  be  put  in  operation. 

There  are  now,  in  readiness,  to  be  distributed  to  various  cities,  9  Geneste- 
Herschel  heaters  and  two  of  the  Clayton  type. 

The  Director  of  the  Santiago  Disinfectory,  from  which  the  other  disinfec- 
tories  of  the  Republic  are  dependent  (see  Annex  F.  i),  has  proposed,  in  a  com- 
munication of  August  20,  1907  (Annex  F.  2),  to  distribute  them  in  the  following 
cities:  At  Arica,  in  order  to  complete  the  equipment  at  the  disposal  of  the 
Sanitary  Station  of  the  North,  installing  as  an  annex  to  the  pest  house  a  public 
disinfectory  that  may  also  be  useful  to  the  needs  of  the  same  station;  2d,  at 
Pisagua;  3d,  at  Talca;  4th,  at  Ovalle;  5th,  at  San  Felipe;  6th,  at  Vina  del 
Mar,  7th,  at  Coronel ;  8th,  at  Valdivia,  and  9th,  at  Puerto  Montt. 

In  1905  (Annex  F.  3)  the  Illustrious  Municipality  of  Santiago  enacted  a  de- 
cree ordering  the  disinfection  of  carriages  in  public  service,  every  two  weeks. 

DWELLINGS  FOR  WORKINGMEN. 

One  of  the  subjects  that  worries  most  the  society  of  Santiago  is  the  dwelling 
and  the  mode  of  living  of  the  poorer  class. 

Private  initiative  is,  to  a  great  extent,  responsible  for  the  progress  attained  in 
this  particular,  at  least  in  the  city  of  Santiago.  There  are  many  towns  that  re- 
cently have  been  founded  on  these  bases,  and  in  which  the  small,  secluded,  dark, 
moist,  etc.,  room  has  been  replaced  by  independent  living  quarters,  well  venti- 
lated, dry,  and  exposed  to  light.  Such  is  the  case  with  the  towns  of  Pio  IX, 
Ovalle,  Leon  XIII,  and  many  others. 

The  Supreme  Government,  on  February  20,  1906,  enacted  a  law  that  creates 
"Councils  for  Workingmen's  Dwellings"  (Annex  G),  which  are  departmental 
councils,  and  Superior  Council  that  seats  at  Santiago  and  is  also  the  Council 
of  that  Department. 

For  this  purpose  the  sum  of  $6,000,000  was  voted. 

IMMIGRATION. 

Long  before  the  earthquake  it  was  observed  that  there  was  a  scarcity  of  help 
in  the  center  and  the  south  of  the  Republic.  This  was  a  cataclysm  in  which 
were  torn  down  many  houses,  and  in  some  towns,  like  Limache,  all  of  them. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  I5/ 

It  was  already  a  year  since  the  paving  and  sewer  works  required  a  great  num- 
ber of  workingmen. 

By  the  middle  of  this  year,  the  Minister  of  the  Interior  sent  a  circular  to  the 
Intendants  and  Governors,  requesting  them  to  furnish  statistical  data  as  to  the 
scarcity  of  workingmen  in  the  various  industries  and  agricultural  works  of  the 
central  and  southern  zones.  After  due  consideration  of  the  matter,  in  the  locali- 
ties, the  authorities  made  an  estimate  of  the  actual  and  urgent  need  of  work- 
ingmen, and  it  was  found  by  the  alluded  officials  that  40,000  men  were  necessary 
for  various  industries  in  that  Republic. 

Wages  were  very  high  in  Santiago;  they  were  doubled  to  start  with,  and 
quadrupled  in  other  places,  like  Valparaiso. 

The  Government  did  not  lose  any  time  to  promote  immigration  in  order  to 
find  a  solution  to  this  alarming  state  of  things. 

A  year  prior  to  the  earthquake,  on  June  24,  1905,  it  had  put  into  effect  a  regu- 
lation for  free  immigration  (Annex  R.  i). 

With  the  purpose  of  extending  this  service  and  in  order  to  draw  the  best 
possible  benefits  from  it,  it  put  in  effect,  on  September  25th,  of  the  current  year 
(Annex  K.  2),  a  new  regulation,  much  more  complete  than  the  previous  one,  by 
which  an  office,  dependent  of  the  Ministry  of  Foreign  Relations,  is  created  in 
Europe,  and  called  "General  Agency  of  Immigration,"  with  the  following  per- 
sonnel : 

i  General  Agent. 

I  Secretary  and  Treasurer. 

4  Special  Agents  with  fixed  residence. 

12  Sub-Agents. 
4  Doctors,  and 

10  Commissaries. 

The  Sanitation,  either  in  connection  with  the  personnel  of  the  public  immi- 
gration, or  with  regard  to  the  public  hygiene  are  duly  taken  into  consideration 
in  the  program  and  regulations  of  immigration.  A  medical  staff  ad  hoc  will 
prevent  the  arrival  in  the  country  of  weak  or  feeble  persons,  or  those  suffering 
from  contagious  diseases. 

The  arrival  of  immigrants  during  the  last  three  years  was  as  follows: 
1905 293 

I9O6 1,221 

1907,  up  to  Sept.,  inclusive 4,828 

SLAUGHTER    HOUSE    SERVICE. 

These  services  have  also  been  the  subject  of  special  attention  during  the  last 
two  years.  On  August  14,  1905,  the  Government  enacted  a  law  ordering  the  re- 
construction of  the  slaughter  house  of  Valparaiso  (Annex  I),  according  to  the 
latest  hygienic  exigencies.  In  September  last,  one  of  its  section  was  put  in 
operation. 

In  Santiago,  two  projects  on  model  slaughter  houses  have  been  submitted  to 
the  Municipality,  but  this  Corporation,  so  far,  has  not  taken  any  decision. 

SANITARY    SERVICE   OF   THE   EARTHQUAKE   OF    1906. 

Before  concluding  this  section,  we  must  take  up  a  subject  that  deserves  to  be 
considered,  viz :  the  public  assistance  at  Valparaiso  in  the  days  following  the 
catastrophe  of  August  16,  1906. 

These  grave  circumstances  required  very  severe  measures  to  be  taken,  dwell- 
ings were  demolished,  tombs  and  coffins  were  opened  in  the  cemeteries,  2,000 
corpses  in  state  of  putrefaction  among  the  demolished  drain  trenches;  every- 
thing tended  to  menace  the  spread  of  patogenic  elements  that  would  have  as  an 
easy  prey  an  exhausted  people,  without  shelter  and  without  proper  food. 

The  corpses  of  the  cemeteries  or  those  that  accumulated  in  public  places  were 
covered  with  quicklime.  The  scarcity  of  transportation  facilities  in  the  moun- 
tains made  it  necessary  to  cremate,  by  the  hundred,  those  that  were  found  in  such 
places. 

It  was  also  necessary  to  cremate,  or  to  bury  a  great  number  of  animals  found  in 
the  ruins,  especially  in  the  Central  Livery  Stables. 

People  lived  in  public  places,  avenues  and  broad  streets  that  soon  became 
foci  of  infection,  due  to  lack  of  drainage,  urinaries  and  water  closets;  this  cir- 


158  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

cumstance  being  remedied  with  the  immediate  construction  of  drainage  con- 
duits and  numerous  water  closets. 

A  special  party  was  charged  to  daily  visit  and  clean  those  closets,  leaving  them 
in  good  condition  and  properly  disinfected.  Each  encampment  had  a  special  place 
designated  for  the  accumulation  of  garbage.  Ten  days  later,  that  is,  on  August 
26th,  it  was  estimated  that  20,000  persons  were  living  in  improvised  encampments. 

The  streets  were  watered  with  solutions  of  copper  sulphide  or  iron ;  the  drain 
trenches  with  cresol  and  phenol,  and  the  garbage  was  burned. 

The  Sanitation  personnel  had  also  to  interfere  in  the  hygiene  of  tents,  bowers, 
houses,  dispensaries  and  hospitals. 

The  service  for  drinking  water  was  also  promptly  established,  by  placing  a 
great  number  of  spigots  in  each  encampment. 

The  number  of  dead  was  more  or  less  2,000,  which  is,  for  a  population  of 
150,000  inhabitants,  at  the  rate  of  1.33  per  cent,  or  somewhat  greater  than  that 
of  San  Francisco,  Cal.,  in  which  catastrophe  452  persons  died,  out  of  a  popu- 
lation of  350,000,  which  is  at  the  rate  of  only  0.12  per  cent. 

The  number  of  wounded  in  that  port  reached  3,800.  Annex  J  graphically 
shows  us  that  those  wounded  in  the  head  and  hands  were  greater  in  number. 
Fractures  occurred  especially  in  the  knees,  and  next  in  the  feet,  and,  finally,  the 
greatest  number  of  dislocations  were  mainly  of  the  shoulders  and  then  the 
ankles.  Full  information  regarding  this  service  can  be  had  in  the  booklet 
entitled  "Medical  Service  of  an  Earthquake,"  that  in  the  name  of  my  dis- 
tinguished colleague,  Dr.  Jose  Grossi,  its  author,  I  have  the  honor  to  present 
you  with  a  few  copies. 


REPORT  OF  DRS.  GENARO  PAYAN  AND  RICARDO  GUTIE- 
RREZ LEE,  DELEGATES  FROM  COLOMBIA. 

Unfortunate  circumstances  foreign  to  the  will  of  our  Government  were  the 
cause  that  prevented  Colombia  from  participating  in  the  previous  Pan-American 
Conventions  that  were  held  in  Washington. 

But  on  this  occasion  to  which  she  has  again  been  invited  she  sends  her  Dele- 
gate and  hastens  to  take  part  in  the  transactions  of  this  Convention  whose 
beneficial  results  for  the  Continent  and  the  West  Indies  are  palpable. 

It  has  been,  and  it  is,  an  arduous  task  for  Colombia  to  carry  out  the  provisions 
of  modern  public  hygiene  because  her  position  in  the  center  of  the  Torrid  Zone, 
the  topography  of  her  land  abundantly  provided  with  valleys  irrigated  by  numer- 
ous rivers,  with  high  mountains  and  extensive  coasts  on  both  oceans,  whose  terri- 
torial area  covers  four  hundred  thousand  square  miles,  still  lacking  in  adequate 
means  of  communication  and  having  scarcely  five  million  inhabitants,  the  action 
of  the  Health  Department  has  not  yet  been  felt  with  all  its  force;  the  Republic 
has,  however,  in  some  of  her  ports  means  for  the  preservation  of  public  health 
at  any  given  moment. 

It  was  thus,  that  during  the  two  years  that  the  Bubonic  plage  ravaged  the 
coasts  of  the  Republic  of  Peru,  we  were  able  to  completely  protect  ourselves 
against  said  disease  although  the  important  shipments  of  salt  from  Paita  and 
Sechura  to  the  Colombian  Ports  of  Buenaventura  and  Tumaca  had  never  been 
interrupted. 

Neither  has  yellow  fever  appeared  in  our  coast  for  some  time  although  the 
ports  are  situated  in  a  latitude  appropriate  for  its  development,  and  in  spite  of 
the  fact  that  in  certain  seasons  of  the  ,year  we  have  considerable  number  of 
Stegomia  Fasciata  which  are  entirely  ha'rmless  due  to  the  absolute  lack  of  the 
virus  in  the  country. 

On  our  Atlantic  coast  where  the  commercial  and  immigration  movement  is 
greater,  a  few  exotic  cases  appear  which  are  never  propogated  among  adult 
natives  but  among  non-acclimated  foreigners  and  among  children  although  in  a 
benign  form;  the  acute  cases  are  called  Borras  Fever. 

In  the  interior  we  have  very  few  cases  of  yellow  fever  which  only  appears 
when  large  movements  of  population  from  the  mountains  to  the  valleys  take 
place,  under  circumstances  that  modify  totally  the  customs,  climate,  food  of,  and 
cause  an  unhealthy  condition  among  the  inhabitants  of  the  highlands,  where 
not  one  single  case  of  the  disease  has  been  recorded. 

One  of  the  really  alarming  diseases  which  has  hindered  our  progress  so  much 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  159 

is  malaria  which,  appearing  under  the  most  varied  and  serious  forms,  produces 
the  greatest  mortality  among  the  inhabitants  of  the  regions  which  are  overflowed 
by  rivers  during  the  rainy  season,  and  also  among  those  of  the  seacoast. 

Malaria  has  been  an  obstacle  to  the  foreign  immigration  that  our  country  needs 
so  much.  It  makes  men  apathetic  and  lazy. 

Such  a  serious  disease  has  always  attracted  the  attention  of  the  Government, 
and  of  the  entire  country,  for  which  reason  the  greater  part  of  the  sanitary  leg- 
islation in  force  refers  especially  to  that  subject. 

Intestinal  diseases  of  various  forms  are  also  frequent  in  Colombia,  such  as 
Enteritis,  Entero colitis,  and  dysentery,  which  appears  in  an  epidemic  form;  hepatic 
diseases,  as  a  complication  of  the  intestinal  ones  end  usually  in  serious  hepatic 
attacks  and  Cirrosis  under  all  its  forms.  Acute  jaundice  appears  frequently  in 
the  more  torrid  regions.  On  the  other  hand,  typhoid  fever  is  endemic  in  the 
temperate  regions  and  in  the  cold  highlands  with  the  same  forms,  variations, 
and  complications  under  which  it  exists  in  Europe  and  with  the  same  laboratory 
reactions  that  are  known  today.  Together  with  this  fever  there  are  the  Coli- 
baccilar  ones,  undefined,  which  may  be  mistaken  for  the  former  when  practice 
and  a  close  clinical  observation  fail  to  give  the  proper  differential  diagnosis. 

Along  the  banks  of  the  Magdalena  and  Patia  Rivers  exists  also  the  disease 
known  as  Leucemia  or  Leucocitemla,  mistaken  for  acute  anemia,  and  character- 
ized by  Hipoglobulia  in  its  extreme  degree  and  hypertrophy  of  the  (?) 
which  is  enlarged  to  ten  times  its  normal  size. 

Tetanus  occurs  in  hot  climates  especially  among  the  newly  born  or  in  traumatic 
cases,  and  frequently  by  reason  of  the  introduction  of  the  Pulex  Penetrans, 

Tuberculosis  plays  an  important  part  in  the  Tropical  Zone  but  not  in  the  high- 
lands where  it  is  unknown  and  where  those  suffering  therefrom  take  refuge  in 
seeking  health. 

Boxio,  in  the  same  form  under  which  it  is  observed  in  Switzerland  and  in 
some  provinces  of  Spain,  exists  in  families  and  towns  of  some  valleys,  and  it  is 
not  uncommon  to  notice  in  some  of  the  persons  suffering  therefrom  Basedow's 
disease  with  cardiac  complications. 

The  skin  disease  known  as  carate,  which  is  characterized  by  a  change  in  some 
parts  of  the  pigment  of  the  human  skin,  and  gives  the  patient  varied  colors 
(blue,  pink,  black,  and  white)  who  then  has  a  most  peculiar  appearance.  It  is 
believed  that  this  Colombian  disease  is  caused  by  the  bite  of  a  certain  mosquito 
that  exists  in  the  mountain  regions  and  which  has  the  power  of  planting  and 
transmitting  the  parasite  of  the  carate,  studied  by  Doctor  Montoya  y  Flores, 
Professor  of  the  University  of  Bogota,  who  a  few  years  ago  addressed  a  com- 
munication to  the  Academy  of  Sciences  of  Paris  in  regard  to  said  insect. 

Bubonic  plague,  beriberi,  cholera  morbus,  and  trachoma  are  diseases  still  un- 
known among  us,  on  account,  perhaps,  of  the  limited  immigration  into  our  coun- 
try. According  to  the  scientific  methods  established,  the  hygienic  and  sanitary 
institutions  of  the  country  will  enforce  the  sanitary  regulations  in  order  to 
prevent  the  transmission  of  said  diseases. 

We  make  mention  of  leper,  at  the  end,  because  this  is  a  disease  that  is  being 
extended  throughout  the  tropical  world  in  a  very  alarming  way,  and  which  exists 
also  in  our  country. 

The  many  cases  that  have  been  observed,  and  about  which  the  press,  reports, 
pamphlets,  and  dermatological  books  have  given  exaggerated,  and  even  false, 
statistics,  have  hindered  our  national  progress,  in  regard  to  immigration,  com- 
merce, and  industry.  The  Government  has  now  adopted  the  necessary  measures 
to  isolate,  and  treat  in  the  most  scientific  manner,  the  patients  that  are  lodged 
in  the  leper  hospitals  in  two  of  the  departments  of  the  country.  Said  hospitals 
are  under  the  management  of  special  boards,  and  are  generally  supported  by  the 
Federal  Government. 

With  the  detailed  report  that  we  will  file  with  the  Secretary  of  the  Convention 
in  due  time,  we  will  enclose  the  sanitary  and  quarantine  laws  of  Colombia,  about 
which  we  must  state  that  they  are  in  conformity  with  the  principles  of  the  con- 
ventions concluded  at  Washington  and  Paris. 

To  conclude,  we  will  say  that  Colombia  has  already  organized  in  an  adequate 
manner  her  public  health  service.  There  is  in  the  capital  of  the  Republic  a 
Central  Board  of  Hygiene,  and  departmental  boards  in  the  capitals  of  depart- 
ments, besides  a  Maritime  Health  Officer  in  each  port.  All  the  boards  referred 
to,  as  well  as  the  Medical  Corps  of  the  Army,  and  the  leper  hospitals,  are  under 
the  supreme  supervision  of  the  National  Executive  Power. 


l6o  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

REPORT  OF  DR.  JUAN  J.  ULLOA,  DELEGATE  OF  COSTA 

RICA. 

Haying  been  appointed  by  the  President  of  Costa  Rica,  Lie.  Don  Clemente 
Gonzalez  Viquez,  to  represent  the  Republic  of  Costa  Rica  at  the  Third  Inter- 
national Sanitary  Convention,  and  for  which  I  have  been  granted  full  and  com- 
plete powers,  I  have  the  honor  to  submit  to  your  consideration  th$  following  sum- 
mary of  the  report  referred  to  in  the  provisional  program  of  the  Convention, 
and  which  comprises  the  period  between  the  I4th  of  October,  1905,  when  the 
important  Sanitary  Convention  of  Washington  adjourned,  and  the  present  date. 

i.  The  Provisional  Program.  Fortunately  during  the  period  of  time  to  which 
this  report  refers,  we  do  not  have  to  record  any  epidemic  of  the  bubonic  plague, 
yellow  fever,  cholera,  beri-beri,  or  trachoma. 

Malaria  does  cause  serious  ravages  in  some  parts  of  the  country,  and  more 
particularly  in  the  low  and  hot  regions  of  our  Atlantic  and  Pacific  Coasts.  There 
is  no  doubt  that  malaria  is  the  greatest  enemy  we  have  to  combat  in  our  coun- 
tries, and  that  the  various  forms  of  this  disease  and  its  complications  are  the 
principal  cause  of  mortality  in  the  tropical  nations  of  America.  Let  us  declare 
relentless  war  against  the  anopheles,  which  are  the  principal  transmitting  agent  of 
malaria,  and  let  us  recommend  to  the  governments  of  this  Continent  the  adoption 
of  efficient  measures  against  this  enemy  of  mankind,  and  we  shall  thus  take  a 
great  step  in  the  way  which  will  lead  us  to  the  best  sanitation  possible  of  the 
bad  sanitary  conditions  of  a  great  portion  of  the  American  Continent. 

During  the  years  1906  and  1907  the  sanitary  condition  of  Costa  Rica,  as  shown 
by  the  numerous  reports  which  I  have  received  from  medical  officers  in  the 
different  sections  of  the  Republic,  which  form  the  basis  of  the  report  I  now 
have  the  honor  to  submit  to  you,  and  some  of  which  you  will  find  in  the 
appendix  thereto,  was  satisfactory. 

Apart  from  the  evils  incidental  to  malaria,  to  an  epidemic  of  typhoid  fever, 
which  broke  out  in  the  city  of  Grecia  in  the  early  part  of  the  current  year,  and 
owing  to  the  ignorance  of  the  people  concerning  the  proper  diet  and  care  of  the 
children,  and  to  the  evils  caused  by  quacks,  we  ought  to  be  thankful  for  the 
favorable  sanitary  conditions  prevailing  throughout  the  Republic. 

If  we  bear  in  mind  that  72  per  cent,  more  or  less,  of  the  mortality  in  Costa 
Rica  occurs  among  children  of  less  than  five  years  of  age,  the  importance  of 
remedying  the  evils  to  which  said  mortality  is  due  will  be  readily  understood, 
said  evils  being  none  other  than  poor  diet,  deficient  clothing,  and  the  lack  of 
the  proper  medical  attendance,  owing  to  the  ignorance  of  the  people  who  prefer 
quacks  to  qualified  physicians. 

It  is  very  gratifying  to  me  to  state  here  that,  thanks  to  the  measures  adopted 
for  the  destruction  of  the  mosquitoes  of  the  stegomya  calopus  variety,  and  to 
prevent  their  propagation  as  well  as  those  recommended  by  modern  science  for 
the  proper  isolation  of  the  first  cases,  the  sanitary  conditions  of  our  Atlantic  and 
Pacific  regions  have  been  excellent  so  far  as  yellow  fever  is  concerned,  a  disease 
which  seems  to  have  already  been  banished  from  said  fields.  During  the  year  two 
or  three  cases  of  said  disease  occurred  on  the  Atlantic  coast,  but  the  actual  exter- 
mination of  the  infectious  foci  prevented  the  danger  in  due  time,  and  the  cases 
to  which  I  have  referred  were  entirely  isolated  cases. 

(!>)  Several  important  improvements  have  been  introduced  in  our  ports  of 
Limon  and  Puntarenas  in  order  to  improve  their  sanitary  conditions.  Their 
respective  municipalities,  efficiently  aided  by  the  National  Government,  have  taken 
great  care  to  improve  the  condition  of  their  streets,  their  systems  of  water 
supply,  the  system  of  drainage  of  the  town,  and  the  sanitation  of  dwellings 
and  public  buildings. 

Maritime  sanitation  has  been  put  in  practice  with  proper  precautions,  and  ves- 
sels and  passengers  coming  from  infected  ports  having  been  subjected  to  quaran- 
tine in  the  strictest  manner,  and  in  accordance  with  modern  methods. 

The  macadamized  streets  have  been  extended  at  Port  Limon,  the  drainage  sys- 
tem has  been  improved,  as  well  as  the  water  supply  mains,  and  important 
improvements  are  now  being  carried  out  in  both  systems,  one  of  which  will  be 
the  proper  connection  of  the  drainage  system  of  the  houses  with  the  sewer 
system  by  means  of  iron  pipes. 

The  National  Government  has  provided  both  ports  with  fumigating  apparatus 
of  the  Clayton  type,  which  have  rendered  excellent  service  in  the  disinfection  of 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  l6l 

houses  and  of  some  vessels.  These  apparatus  are  of  the  H  type,  and,  together 
with  their  corresponding  steam  motor,  are  easily  transported  to  the  place  where 
they  are  needed,  by  means  of  the  wheelbarrows  on  which  they  are  mounted.  I 
have  seen  these  apparatus  in  operation  and  am  entirely  convinced  of  their  effi- 
ciency for  the  destruction  of  rats,  mosquitoes,  bedbugs,  fleas,  and  other  kinds  of 
insects.  The  gas  which  they  produce  is  trioxide  of  sulphur,  which,  before  it 
penetrates  the  dwellings  through  the  proper  pipes,  is  cooled  down  through  coiled 
tubes  through  which  cold  water  circulates,  which  constitutes  a  part  of  the 
generating  apparatus.  This  machine  is  a  double  action  apparatus,  and  is  used 
for  extracting  the  air  from  dwellings  and  vessels  before  the  sulphurous  gas  is 
introduced  therein,  and  is  also  used  to  inject  pure  air  after  the  disinfection  takes 
place.  It  seems  that  said  gas  does  not  injure  fabrics  or  furniture.  At  present 
these  apparatus  are  used  in  several  of  the  American  countries,  and  I  believe 
that  they  can  be  conscientiously  recommended  to  those  countries  that  have  not 
yet  adopted  them. 

At  Puntarenas,  and  especially  at  Port  Limon,  we  have  two  quarantine  stations 
which,  though  somewhat  deficient,  render  good  service.  The  Government  which 
I  have  the  honor  to  represent,  proposes  to  construct  at  the  Island  of  Uvita, 
situated  opposite  Port  Limon,  and  about  a  half  mile  distant  therefrom,  the  neces- 
sary buildings  for  establishing  there  a  quarantine  service,  in  accordance  with  the 
plans  which  I  had  the  honor  to  submit  last  year,  as  a  consequence  of  the  Com- 
mission with  which  I  was  entrusted.  A  suitable  installation  for  the  quarantine 
service  of  the  port  of  Puntarenas  will  also  soon  be  made. 

(c)  One  of  the  most  praiseworthy  achievements  of  the  present  administration 
of  Costa  Rica  has  been  the  earnest  support  and  efficient  help  which  the  National 
Government  has  rendered  to  the  different  municipalities  of  the  Republic  for  the 
purpose  of  improving  their  sanitary  conditions,  and,  more  especially,  for  the 
laying  of  the  systems  of  water  mains  for  the  potable  water  supply.    Since  the 
present  administration  has  been  in  control,  it  has  efficiently  helped  the  construc- 
tion of  at  least  ten  water  mains,  and  there  are  more  under  construction.    The 
Government  has  promised  to  help  other  towns  along  these  lines. 

One  of  the  most  important  improvements  about  to  be  undertaken  is  the  exten- 
sion and  improvement  of  the  water  mains  of  San  Jose,  and  the  general  system  of 
sewers  in  the  same  city.  These  works  will  cost  approximately  $1,000,000.  Lately 
the  sanitary  conditions  of  the  capital  of  the  Republic  have  been  considerably 
improved,  and  the  new  boroughs  that  are  being  opened  for  the  extension  of  the 
town,  are  put  in  good  sanitary  condition  before  buildings  are  constructed  thereon. 

In  the  other  principal  cities  of  the  country,  important  sanitary  improvements 
have  also  been  introduced. 

(d)  Since  the  I4th  of  October,  1905,  several  sanitary  police  laws  have  been 
promulgated,  as  you  will  see  from  the  respective  appendices. 

The  most  important  provision  made  in  the  sanitary  branch  of  the  Government 
was  the  ratification,  by  the  National  Congress,  during  its  regular  sessions  of 
1006,  of  the  .International  Sanitary  Convention  held  in  Washington  on  October 
14,  1905,  by  the  representatives  of  the  governments  which  participated  in  the 
Second  International  Sanitary  Congress,  and  which  will  be  the  law  to  govern  in 
the  important  matter  of  sanitary  police  of  the  American  Continent. 

Quarantine  was  declared  against  vessels  coming  from  the  port  of  Havana, 
on  account  .of  the  cases  of  yellow  fever,  which,  unfortunately,  occurred  lately 
in  Cuba,  as  well  as  inspection  quarantine  against  vessels  coming  from  San 
Francisco,  Cal.,  owing  to  the  bubonic  plague  prevailing  in  said  city. 

Special  measures  have  been  taken  against  tuberculosis,  syphilis  and  the 
morphine  habit. 

2.  The  practical  methods  which  I  beg  to  suggest  in  order  to  prevent  the  trans- 
mission of  tuberculosis  in  traveling  vehicles,  are  .those  which  are  already  known 
and  accepted  generally,  namely :  the  proper  disinfection  of  railroad  cars  and  the 
staterooms  and  berths  of  vessels.  The  provision  of  portable  cuspidors,  punish- 
ment by  heavy  fines  of  persons  who  expectorate  on  the  floor  of  cars,  berths,  etc., 
and  the  thorough  and  careful  disinfection  of  all  the  utensils  employed  by  con- 
sumptives or  those  who  are  suspected  of  being  afflicted  with  tuberculosis. 

4.  The  organization  of  a  commission  composed  of  three  physicians,  or  health 
officers,  intended  to  constitute  a  part  of  the  International  Sanitary  Information 
Commission  of  the  American  Republics,  may  be  entrusted,  so  far  as  Costa  Rica 
is  concerned,  through  the  National  Government,  to  the  medical  faculty,  which 


l62  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

is  the  advisory  authority  of  the  country,  in  matters  relating  to  sanitary  measures 
or  sanitary*  police. 

5.  It  seems  to  me  that  the  establishment  of  the  Bureau  of  Sanitary  Informa- 
tion  of  Montevideo,   in   accordance   with   the   provisions   of  paragraph   3    (c) 
and  paragraph  4  of  the  resolutions  adopted  in  Rio  de  Janeiro,  is  very  desirable. 

6.  I  also  consider  very  important  the  establishment  of  relations  between  the 
International  Sanitary  Bureau  established  in  Washington  and  the  International 
Sanitary  Office  of  Paris. 


GENERAL  REPORT  PRESENTED  BY  DRS.  HUGO  ROB- 
ERTS AND  JUAN  GUITERAS,  DELEGATES  FROM  CUBA. 

The  provisional  programme  for  this  Convention,  to  which  I  have  the  honor 
of  belonging,  includes  a  memorial  by  the  Delegate  of  each  Nation,  which  shall 
contain  a  report  respecting  the  contagious  and  infectious  diseases  prevalent  in 
his  territory,  as  also  the  conditions  of  the  ports,  the  aid  furnished  by  the 
Government  to  the  Municipalities  or  States,  and  ,the  Sanitary  Police  Laws 
promulgated  after  October  14,  1905. 

Allow  me  first  to  occupy  myself  with  our  sanitary  organization,  for  once 
understanding  what  we  might  term  its  "anatomy,"  it  is-  much  easier  to  interpret 
its  functions  and  also  to  judge  of  its  results. 

In  Cuba,  the  superior  sanitary  body  is  the  National  Sanitary  Board,  composed 
of  members  of  the  Sanitary  Administration,  including  a  Lawyer  and  an  Engineer, 
as  advisers  on  technical  questions. 

Not  only  does  this  Board  exercise  supervision  over  all  sanitary  matters,  but 
it  is  also  a  Consulting  Board  for  all  hygienic  questions ;  its  President  is  the 
Chief  Sanitary  Officer. 

On  this  basis,  the  service  is  divided  into  two  important  branches :  the  Quaran- 
tine Service  or  that  of  external  defense,  and  the  Interior  Sanitary  Service,  whose 
object  is  to  afford  internal  protection. 

QUARANTINE    SERVICE. 

The  object  of  this  service  is  to  compel  the  carrying  put  of  the  Quarantine 
Laws  and  Regulations,  the  same  being  in  force  in  the  United  States  of  America 
at  the  time  they  were  promulgated  in  Cuba;  these,  later  on,  were  modified  in 
order  to  adjust  them  to  recent  advances  in  science.  In  order  to  reap  the 
great  advantages  obtained  in  taking  all  measures  as  promptly  as  possible,  the  Law 
provides  what  must  be  done  by  all  vessels  in  an  infected  locality  and  also  the 
measures  to  be  adopted  by  the  same  at  sea,  should  a  quarantine  case  occur  on 
board;  and  furthermore  the  requirements  to  be  observed  in  Cuban  ports,  should 
sufficient  precautions  against  the  transmission  of  the  epidemic  not  have  been 
taken  at  the  port  of  sailing. 

The  introduction  of  all  epidemic  disease  should  be  prevented,  and  especially 
those  termed  quarantinable,  being  the  following  according  to  our  law:  yellow 
fever,  plague,  cholera,  small-pox,  leprosy  and  typhus. 

•  Although  this  law  does  not  make  a  final  classification  of  vessels  according 
to  their  sanitary  conditions  on  sailing  from  or  arriving  at  a  port,  still  the 
standard  accepted  in  Cuba,  allows  us  to  classify  them  under  three  heads : 
"Infected,"  "Suspected"  and  "Indemne." 

An  "Infected"  vessel  is  one  on  which  no  precautions  have  been  taken  on 
sailing  from  an  infected  port,  thereby  accepting  the  possibility  of  the  existence 
on  board  of  the  pathogenic  agent,  which,  until  destroyed,  might,  at  any  time, 
infect  some  person  on  board.  These  vessels  on  arrival  at  Cuban  ports  are 
fumigated,  and  the  crew  and  passengers  detained  for  a  time  covering  the 
incubation  of  the  disease  in  question. 

A  "Suspected"  vessel  is  one  which,  though  sailing  from  an  infected  port,  by 
having  observed  the  required  precautions,  the  possibility  of  its  having  on  board 
the  pathogenic  agent,  cannot  be  entertained,  nevertheless,  some  person  on  board 
might  be  in  the  incubative  period  of  the  disease  acquired  by  infection  during  the 
stay  of  the  vessel  in  the  infected  locality.  Such  ships  are  not  fumigated  in 
Cuba,  but  the  personnel  is  detained  in  Quarantine  during  the  period  of  incuba- 
tion of  the  disease;  the  said  period  begins  to  count  from  the  last  moment  in 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  163 

which  they  were  exposed  to  the  disease,  that  is  to  say,  from  the  time  they  left 
the  infected  locality. 

An  "Indemne"  vessel,  in  the  true  acceptance  of  the  word,  which  means: 
"exempt  from  harm,"  is  one  on  which  the  existence  of  a  pathogenic  agent  cannot 
be  entertained,  and  on  which  the  passengers  and  crew  could  not  possibly  be 
in  the  incubative  period  of  any  disease,  either  because  no  quarantinable  disease 
existed  at  the  port  of  departure  or  because  all  proper  precautions  had  been 
taken  before  sailing. 

It  is  therefore  easy  to  understand  that  a  ship  changes  from  an  "Infected"  to  a 
"Suspected"  class  by  fumigation,  and  from  "Suspected"  to  "Indemne,"  through 
the  course  of  time;  that  the  appearance  of  quarantinable  disease  on  board  a 
"Suspected"  ship,  immediately  changes  it  or  part  of  it  into  an  "Infected"  one, 
which  may  through  fumigation  again  be  turned  into  a  "Suspected"  ship. 

This  was  the  opinion  sustained  by  the  delegates  of  Cuba  to  the  Second  Inter- 
national Sanitary  Convention,  held  in  Washington  in  October,  1905,  and  in 
conformity  with  said  opinion,  Regulations  were  made  for  our  defense  against 
Yellow  Fever. 

On  the  8th  of  last  May,  the  resolutions  adopted  by  the  above  cited  Convention 
were  promulgated  and  put  in  force  by  the  Honorable  Provisional  Governor 
of  Cuba;  and,  the  requirements  contained  in  Chapter  i,  Articles  I,  II,  III  and 
IV,  by  which  it  is  obligatory  to  report  not  only  the  first  appearance  of  confirmed 
cases  of  Plague,  Cholera  or  Yellow  Fever  in  the  country,  but  also  to  remit  a 
detailed  account  of  the  locality  where  the  case  or  cases  appeared,  the  origin 
and  form  of  the  same,  etc.,  etc.,  were  carried  out  by  our  State  Department. 

There  are  twenty-three  ports  open  to  foreign  commerce  in  Cuba,  FIVE  as 
Quarantine  Stations,  containing  everything  necessary  to  handle  any  ship,  besides 
two  fully  equipped  Stations  (Lazaretos),  one  in  Havana  and  the  other  in 
Santiago  de  Cuba,  with  Hospitals  sufficient  for  any  contingency  which  might 
arise.  Each  port  has  a  competent  staff  available  for  its  needs.  There  are  FIVE 
doctors  attached  to  the  Cuban  Consulates  in  foreign  ports  with  which  we  have 
close  commercial  ties  or  which  send  us  great  currents  of  emigration. 

Vaccination  is  obligatory  in  Cuba.  The  Officers  of  the  Quarantine  Service 
vaccinate  arrivals  from  foreign  countries. 

This  Service  costs  the  Cuban  Government  about  ONE  HUNDRED  AND  THIRTY 
THOUSAND  DOLLARS  a  year.  Fumigations,  Bills  of  Health,  etc.,  are  entirely 
gratuitous. 

There  are  no  sanitary  fees,  and  when  any  one  is  sent  to  the  Quarantine 
Stations,  his  maintenance  is  supplied  by  the  consignees  of  the  ship,  the  State 
defraying  all  the  rest  of  the  expense. 

IMMIGRATION. 

The  Immigration  Department  is  a  complementary  branch  of  the  Quarantine 
Service.  This  Department  has  charge  of  the  physical  examination  of  the 
immigrants,  with  the  object  of  preventing  the  introduction  into  Cuba  of  persons 
whose  immigration  is  prohibited,  either  because  their  habits  might  be  the  source 
of  danger  to  the  community,  or  because  they  may  have  some  physical  defect 
which  sooner  or  later  may  oblige  them  to  resort  to  begging  or  to  apply  to 
asylums  for  the  poor,  or,  owing  to  their  suffering  from  contagious  or  loathsome 
diseases,  which  are  not  necessarily  quarantinable. 

In  Havana  this  important  mission  is  entrusted  to  the  Immigration  Department, 
and  in  the  rest  of  the  Ports  of  the  Island,  the  Collectors  of  Customs  perform 
the  duties  of  Commissioners  of  Immigration,  in  which  the  Doctors  of  the  Port 
co-operate. 

For  the  purposes  of  the  Immigration  Law,  foreigners  who  come  under  any 
of  the  prohibitions  or  restrictions  contained  in  said  Law,  may  be  divided  into 
two  great  groups :  to  the  one  group  correspond  those  whose  habits  or  nationality 
bar  them  from  immigrating;  to  the  other  belong  idiots,  insane  persons,  those 
suffering  from  loathsome  or  contagious  diseases,  such  as  Favus,  Leprosy, 
Syphilis,  Tracoma  and  Tuberculosis  of  the  lungs.  All  immigrants  who  have 
physical  deformities  and  who  may  therefore  become  a  public  charge  shall  be 
returned. 

Immigrants  free  from  all  disease  or  physical  deformity  who  arrive  in  Cuba 
in  a  state  of  pauperism,  are  lodged  in  the  Triscornia  Barracks,  until  proper 
work  is  found  for  them. 


164  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

NATIONAL   SANITARY   DEPARTMENT. 

To  this  Department  is  intrusted  the  preservation  of  the  Public  Health  within 
the  nation.  Under  its  supervision  are  all  the  branches  of  Public  Health  Service 
such  as  Hospitals,  Sanatoria,  etc. 

Each  Municipal  District  has  a  local  Sanitary  Chief,  with  the  necessary  auxiliary 
Staff;  the  number  of  persons  employed,  and  likewise  the  salaries  of  the  officers, 
are  fixed  in  proportion  to  the  population  of  the  district. 

The  superior  direction  of  the  Department  is  vested  in  a  Board  composed  of 
six  members,  among  whom  are  included  a  Lawyer  and  an  Engineer  as  advisers. 
The  Chief  Sanitary  Officer  is  the  President  of  the  Board. 

This  National  Sanitary  Board  has  general  supervision  over  all  matters  con- 
cerning public  health  and  sanitation  in  all  the  Republic. 

It  makes  sanitary  investigation  of  the  causes  of  diseases,  especially  those  of 
an  epidemic  character;  including  diseases  of  animals;  the  cause  of  malaria, 
and  the  effects  produced  on  the  public  health  by  localities,  conditions,  habits, 
liquors  and  medicines. 

It  publishes  the  useful  results  obtained,  and  distributes  popular  instruction 
on  these  and  other  similar  questions. 

It  compels  the  enforcement  of  the  Sanitary  Laws,  including  the  laws  regulat- 
ing the  admission  to  the  practice  of  medicine  and  surgery,  veterinary  medicine, 
pharmacy,  dental  surgery,  obstetrics,  embalming,  funeral  agencies,  prostitution, 
and  also  the  laws  regulating  dangerous  and  noxious  industries  and  occupations. 

It  compels  the  carrying  out  of  all  measures  throughout  the  Republic,  respecting 
the  water  supply,  sewers,  garbage  and  street  sweepings,  adulteration  of  foods, 
liquids  and  drinks,  and  also  those  concerning  the  importation  and  treatment 
of  the  cattle  for  slaughter. 

It  maintains  in  Havana  a  Biological,  Chemical  and  Bacteriological  Laboratory, 
fully  equipped  with  apparatus  and  instruments,  and  with  a  competent  staff  to 
carry  out  bacteriological  studies  and  to  examine  foods. 

Besides  these,  there  are  Special  Commissions,  who  are  oblige^  to  examine,  so 
as  to  ratify  or  rectify,  all  suspected  cases  of  contagious  disease  which  might 
become  epidemic. 

Depending  likewise  directly  on  the  National  Sanitary  Board  are  the  dispen- 
saries and  official  sanatoria,  the  Central  Bureau  of  Vaccination  and  the  Special 
Hygienic  Service.  (This  last  has  in  charge  all  matters  referring  to  prostitution, 
and  has  branches  in  different  cities  of  the  Republic.) 

Also  depending  on  the  National  Sanitary  Board,  is  the  "Las  Animas"  Hospital, 
destined  exclusively  for  patients  suffering  from  contagious  diseases;  this  estab- 
lishment is  specially  equipped  for  this  object. 

And,  lastly,  the  Maternity  and  Orphan  Asylum,  the  Hospitals  of  Societies  as 
well  as  private,  are  under  the  supervision  of  the  National  Sanitary  Board. 

YELLOW  FEVER. 

In  the  month  of  November,  1905,  we  were  surprised  by  an  outbreak  of  yellow 
fever  in  Havana,  the  more  so,  that  from  September  28,  1901,  not  a  single 
autochthonous  case  had  been  registered,  and,  in  order  to  avoid  its  introduction, 
all  measures  and  suggestions  taught  by  recent  scientific  discoveries,  touching 
the  transmission  of  the  disease  through  the  "Stegomya"  mosquito  had  been 
stringently  carried  out.  The  spread  of  the  epidemic,  new  cases  arising  before 
the  necessary  time  had  elapsed  for  the  intrinsic  and  extrinsic  incubation  of  the 
pathogenic  agent  proceeding  from  the  original  case,  revealed  the  existence  of  an 
epidemic  amongst  us,  very  evidently  proving  that,  either  a  group  of  infected 
"Stegomyas"  had  succeeded  in  entering  this  country,  or  that  some  infected 
person  had  formerly  existed,  notwithstanding  pur  efforts  to  discover  him,  and 
in  spite  of  the  thorough  investigation  carried  out.  The  problem  remains 
unsolved;  the  introduction  of  yellow  fever  into  Cuba  can  only  be  hypothetically 
explained;  and,  as  is  natural  among  all  these  different  hypothesis  advanced  to 
explain  the  fact,  we  must  accept  the  one  having  the  most  probabilities. 

If  we  consider,  that  in  the  month  of  May,  1905,  an  epidemic  of  yellow  fever 
broke  out  in  New  Orleans,  of  which  we  had  no  knowledge  in  Cuba  until  the 
latter  part  of  the  month  of  July,  when  defensive  measures  against  that  city 
were  adopted,  it  is  not  unlikely  to  suppose,  that  during  such  lapse  of  time,  some 
person  being  in  the  period  of  incubation  and  not  being  under  observation,  had 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  165 

landed  in  Cuba ;  or  that  some  ship  from  New  Orleans  had  been  allowed  to  move 
about  freely,  thus  permitting  infected  "Stegomyas"  to  reach  the  city. 

From  the  time  the  first  case  appeared  in  the  year  1905,  until  November  7 
1907,  322  cases  with  98  deaths  have  occurred  in  all  the  Island,  and,  if  we 
consider  the  large  non-immune  population  we  have  at  present,  it  is  easy  to 
understand,  that  though  it  is  true  that  the  epidemic  still  exists,  it  has  not  reached 
the  proportion  that  such  epidemics  usually  acquire,  owing  to  the  tenacity  with 
which  it  has  been  fought,  notwithstanding  the  disturbed  conditions  of  affairs. 

The  means  employed  to  check  the  epidemic  are  those  that  would  logically 
occur  to  any  one  in  view  of  the  manner  of  its  propagation.  To  ratify  or 
rectify  the  diagnosis  of  every  person  who  may  be  suspected  of  suffering  from 
yellow  fever;  isolation  of  the  patient,  and  disinfection  of  all  places  where  the 
disease  is  liable  to  have  been  taken,  and  likewise  those  places  which  in  their 
turn  he  may  have  infected  during  the  contagious  period  of  the  disease. 

In  infected  localities,  wherever  it  was  possible  to  daily  inspect  npn-immunes, 
this  has  been  done,  and  whenever  a  non-immune  has  changed  his  residence, 
the  different  Sanitary  Officers  have  been  notified  so  that  the  person  may  continue 
under  observation  during  the  probable  period  of  incubation. 

Besides  these  precautions,  all  Quarantine  as  well  as  Public  Health  officers 
respectively,  watch  all  routes  by  which  an  epidemic  may  be  introduced,  carrying 
out  all  the  measures  ordered,  on  the  least  suspicion,  and  immediately  reporting 
to  their  superior  officer,  the  President  of  the  National  Sanitary  Board. 

PLAGUE. 

Notwithstanding  the  numerous  vessels  that  daily  arrive  in  Cuba  from  places 
infected  by  the  Yersin  bacillus,  we  have  fortunately  not  had  to  lament  the 
occurrence  of  a  single  case.  Special  care  is  taken  to  avoid  the  landing  of  rats 
from  these  vessels.  Recognizing  the  importance  that  rats  represent  in  the 

Sropagation  of  the  plague,  and  their  swimming  powers  being  so  great,  the 
uarantine  Service  experimentally  tried  to  estimate  this  faculty;  therefore,  six 
rge  rats  were  thrown  into  the  Bay  of  Havana,  and  their  movements  observed 
from  a  small  boat.  From  this  simple  experiment  the  following  was  deduced: 
First.  That  rats  are  able  to  remain  on  the  surface  for  a  length  of  time  varying 
from  35  to  45  minutes.  Second.  That  they  do  not  swim  in  a  straight  line,  but 
forming  irregular  zig-zags,  probably  owing  to  the  small  horizon  visible  to  them. 
Third.  That  if  they  happen  to  see  any  object,  increasing  their  exertions,  they 
steer  for  it,  and  if  able  to  seize,  they  do  not  abandon  it,  unless  obliged  to  by 
superior  force.  From  these  observations,  the  following  practical  results  may 
be  obtained :  That  it  is  sufficient  to  anchor  the  vessel,  for  fumigating  purposes, 
at  a  distance  of  50  meters,  which  rats  do  not  cross,  unless  carried  by  the  current 
or  some  floating  object.  That  floats  should  be  placed  near  the  vessel  so  that 
rats  on  falling  into  the  water  may  find  refuge  upon  them  and  thus  be  easily 
despatched. 

MALARIA. 

In  the  Island  of  Cuba,  as  in  all  intertropical  countries,  malaria  has  been  quite 
prevalent,  and  only  through  the  constant  sanitary  work  done,  thereby  avoiding 
as  much  as  possible  the  propagation  of  the  "Anopheles"  mosquito,  have  we  been 
able  to  diminish  the  number  of  cases.  This  work  of  Municipal  sanitation  was 
included  in  the  "Sanitary  Ordinances"  which  the  Cuban  delegates  presented  to 
the  Second  International  Sanitary  Convention. 

Moreover,  the  systematic  campaign  waged  against  the  "Stegomya"  includes 
the  "Anopheles"  also,  and  this  has  been  the  cause  of  greatly  diminishing  Malaria. 

The  number  of  deaths  owing  to  this  disease  has  gradually  decreased.  In 
Havana  in  the  year  1890,  they  reached  909,  and  last  year  26  occurred.  These 
numbers  are  the  most  evident  proof  of  the  success  obtained  in  the  sanitation  of 
the  city. 

TUBERCULOSIS    AND   TRACHOMA. 

The  fact  that  a  person  suffers  from  either  one  of  these  two  diseases  is  in  itself 
sufficient  cause  to  bar  him  from  landing  in  Cuba,  in  conformity  with  the  provi- 
sions contained  in  the  Laws  of  Immigration. 

In  order  to  contend  with  these  diseases  in  our  territory,  as  well  as  against 
others  equally  contagious  and  transmissible,  the  National  Sanitary  Department 


l66  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

has  adopted  numerous  and  efficient  restrictive  measures,  among  which  are,  the 
prohibition  to  attend  schools,  colleges,  workshops,  factories,  etc.,  to  children, 
employees  and  workmen  suffering  from  transmissible  diseases  or  who  come  from 
houses  where  such  a  disease  exists,  or  until  they  have  obtained  the  proper 
discharge  as  cured. 

A  special  Sanatorium  for  consumptives  is  at  present  being  built  as  an  experi- 
ment, in  a  suitable  place  in  the  Province  of  Havana. 

There  are  negotiations  pending  for  the  purchase  of  a  suitable  property  to 
which  the  "San  Lazaro"  Hospital  will  be  removed  after  making  the  necessary 
repairs  and  improvements.  This  Hospital,  where  lepers  are  housed,  mars  the 
appearance  and  defaces  the  city,  being  besides  very  inconvenient  for  the  purpose. 

And,  finally,  in  many  cities  of  the  Island  plans  are  being  made  for  the  building 
of  aqueducts  and  sewers,  which  will  contribute  greatly  to  the  sanitation  of  the 
different  towns  and  cities,  the  most  important  being  those  of  Havana,  Cienfuegos 
and  Santiago  de  Cuba. 

REPORT  ON  YELLOW  FEVER. 

Extract  from  the  report  made  to  the  Provisional  Governor  of  Cuba  by  Dr. 

Juan  Guiteras,  Chairman  of  the  Committee  on  Infectious 

Diseases,  and  Dean  of  the  Faculty  of  Medicine. 

This  report  is  based  on  a  tour  of  inspection  to  the  City  of  Cienfuegos,  and 
to  the  central  provinces  of  the  Republic  in  the  month  of  September  of  the 
current  year. 

On  the  day  of  my  arrival  in  Cienfuegos,  on  the  ipth  of  September,  it  was 
apparent  that  the  breaking  out  of  the  epidemic  was  rapidly  yielding  to  the 
efforts  of  the  sanitary  authorities  charged  with  combatting  the  same.  On 
leaving  the  city  on  the  22d  of  said  month,  there  remained  only  five  cases,  three 
of  which  had  originated  in  the  neighboring  towns  of  Guaos,  Caunao  and  Soledad. 

What  happened  at  that  time  was  in  accord  with  our  experience  during  the 
last  few  years,  since  the  new  outbreak  of  yellow  fever  in  Cuba  in  1905.  It 
has  happened  ever  since  that  the  disease  is  under  control  in  the  centers  of 
population  where  the  sanitary  organization  can  exercise  prompt  and  efficient 
action,  while  in  the  country,  on  the  contrary,  the  disease  keeps  dragging  from 
one  place  to  another,  having  an  existence  more  or  less  unknown. 

This  prevalence  of  yellow  fever  at  places  in  the  country  is  a  very  interesting 
phenomenon,  which  now  occupies  our  attention  with  all  the  interest  of  a 
problem  of  great  practical  importance.  But  we  should  not  regard  it  as  a  new 
thing.  In  former  times,  before  yellow  fever  was  eliminated  from  the  Island, 
the  authorities  did  not  pay  much  attention  to  the  prevalance  of  the  infection 
in  the  city  of  Havana,  and  paid  much  less  attention  to  cases  in  country 
places.  The  disease  could  easily  spread  from  one  place  to  another  without 
attracting  the  attention  of  any  one,  unless  it  should  encounter  some  observing 
person  like  Dr.  Pedro  Albarran,  who  had  the  good  fortune  and  talent  to 
photograph  one  of  those  peculiar  rural  epidemics  among  the  native  population. 

Whether  any  records  existed  concerning  the  wanderings  of  this  disease,  we 
have  reason  to  suppose  that  they  were  not  lacking,  since  such  is  the  history 
of  all  epidemic  diseases.  Smallpox,  scarlet  fever,  and  cholera,  have  migrated 
from  the  centers  of  population  to  the  rural  districts,  and  from  the  latter  again 
to  the  centers  of  population  in  the  form  of  a  small  secondary  epidemic,  thus 
maintaining  the  conditions  called  endemic. 

This  flux  and  reflux  of  the  tide  may  be  easily  followed  in  the  annexed  drawing, 
which  presents  in  synopsis  the  course  of  yellow  fever  since  its  introduction  into 
Cuba  in  the  fall  of  1905.  The  cases  which  occurred  in  the  cities  of  Havana 
and  Cienfuegos  are  marked  with  black  and  red  triangles,  respectively,  while 
those  which  originated  out  of  the  Capital  are  marked  in  red  letters.  There 
may  be  seen  in  said  drawing  how,  during  the  administration  of  President 
Estrada  Palma,  the  disease  was  extinguished  in  Habana  in  February,  1906; 
how  the  infection  continued  in  the  rural  districts,  and  how  Habana  was  again 
infected  in  June  and  August  of  the  same  year  from  said  districts.  The  repeti- 
tion of  the  same  events  during  the  present  administration,  may  also  be  followed 
in  said  drawing. 

The  epidemic  at  Cienfuegos  was  also  probably  imported  from  the  rural  dis- 
tricts. At  the  end  of  the  summer  of  1906,  the  interruption  of  communication 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  167 

with  Habana,  brought  about  by  the  political  disturbances  and  insurrectional 
outbreaks,  impeded  or  delayed  the  detection  and  control  of  a  small  epidemic 
outbreak  in  Cruces,  though  this  outbreak  was  eventually  controlled  by  Capt. 
H.  D.  Thomaspn,  and  Dr.  Claudio  Delegado.  However,  we  may  presume  that 
the  rural  territory  extending  from  Cruces  and  Cienfuegos,  have  served,  by 
means  of  sporadic  cases,  as  a  slow  fire  concealed  in  the  explosions. 

We  should,  therefore,  devote  our  attention  more  than  we  have  done  here- 
tofore, to  rural  districts.  Active  and  experienced  inspectors  in  the  diagnosis 
of  yellow  fever  should  be  kept  traveling  through  the  provinces.  They  will,  of 
course,  be  under  the  orders  of  the  Department  for  the  purpose  of  investigating 
and  reporting  concerning  suspicious  cases  that  may  develop  in  any  place.  While 
they  are  not  obeying  direct  orders  from  the  Department,  they  shall  travel  on 
their  own  initiative  and  consult  the  local  authorities  and  physicians,  examine 
the  statistics  of  mortality  in  the  several  municipalities,  and  shall  endeavor  to 
inform  themselves  concerning  the  sanitary  conditions,  and  the  direction  of  the 
currents  of  working  men  and  immigrants. 

In  this  second  visit  that  I  made  to  Cienfuegos,  I  was  enabled  to  confirm  the 
forecast  which,  together  with  Dr.  Finlay,  we  had  made  during  our  previous 
visit  in  the  middle  of  August,  and  I  mention  this  fact  merely  because  under 
the  present  circumstances  it  is  proper  to  call  especial  attention  to  some  points 
in  the  epidemiography  of  yellow  fever. 

Upon  our  arrival  at  Cienfuegos  in  August,  we  found  a  very  violent  outbreak 
of  the  disease  in  the  American  garrison,  which  contrasted  with  very  slow  evo- 
lution of  the  infection  among  the  civil  population.  Among  the  troops  a  group 
of  fifteen  men  (soldiers  of  the  sanitary  corps)  within  a  very  few  days  had 
caused  seven  infections,  while  among  the  civil  population  of  the  city  only 
three  had  occurred.  In  spite  of  this  threatening  aspect  of  the  outbreak  in  the 
garrison,  we  were  able  to  foretell  that  the  infection  would  be  rapidly  extin- 
guished in  that  camp,  and  that  it  would  cause  a  great  deal  of  trouble  in  the  city. 

The  fundamental  difference  between  the  two  outbreaks  was  the  following: 
In  that  which  occurred  in  the  soldiers'  camp  we  had  reason  to  believe  that  we 
had  to  deal  with  an  initial  outbreak  among  the  soldiers.  The  first  cases  had 
been  detected  and  properly  treated;  we  knew  precisely  where  the  troops  had 
bcome  infected;  we  knew  that  the  infecting  mosquitoes  must  have  been  in  a 
recently  constructed  wooden  barrack  which  was  built  as  an  extension  to  the 
building  which  they  had  been  using  as  a  military  hospital — a  barrack  which 
was  occupied  by  the  soldiers  of  the  sanitary  corps,  in  fact,  we  could  almost 
tell  the  number  of  infected  mosquitoes  in  the  barrack.  Therefore,  it  was  to  be 
presumed  that  a  thorough  fumigation  of  said  barrack  would  terminate  the  out- 
break of  yellow  fever  in  the  garrison,  and  so  it  was,  in  fact,  because  said 
outbreak  came  to  an  end  just  as  suddenly  as  it  began. 

On  the  contrary,  in  the  city  the  situation  was  unknown.  The  three  cases 
which  had  been  denounced  came  from  different  wards  of  the  city,  and  it  was 
impossible  to  determine  where  the  infection  had  been  contracted.  It  was 
evident  that  other  cases  not  detected  had  occurred  before  the  denounced  cases. 
Probably  some  of  these  had  infected  the  mosquitoes  of  the  aforesaid  barracks, 
and  at  all  events  it  was  feared  that  a  very  active  campaign  would  be  necessary 
in-  order  to  extinguish  the  infection. 

Such  has  been  the  campaign  that  is  being  carried  out  under  the  direction  of 
Captain  Thomason,  with  the  co-operation  of  Dr.  Claudib  Delgado,  in  charge 
of  the  Department  of  Investigation  and  Diagnosis,  and  of  Dr.  Custodio,  who 
has  charge  of  the  sanitation  and  disinfection  works. 

The  methods  employed  by  Dr.  Thomason  are  the  same  as  those  employed 
by  Dr.  Gorgas  in  1901,  which  constitute  the  practical  application  of  the  Finlay 
doctrine.  It  is  proper  here  to  state  that  the  rules  which  said  doctrine  imposes 
are  two,  viz.: 

1.  The  treatment  of  the  infecting  material,  that  is  to  say,  the  patient  and  the 
infected  mosquitoes.    This  is  accomplished  by  isolating  the  patient  under  wire 
gauze  against  insects  and  by  the  destruction  (fumigation)  of  such  mosquitoes 
as  have  bitten  the  patient. 

2.  A  general  campaign  in  order  to  prevent  the  breeding  of  the  stegomyas 
for  the  purpose  of  obtaining,  even  though  only  temporarily,  the  extinction  of 
that  specie  in  the  locality. 

The  discussion  concerning  the  relative  importance  of  these  two  rules  seems 
useless.  We  must,  of  course,  recognize  as  an  incontrovertible  truth,  that  either 


168  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

of  the- two  rules  by  itself  would  be  sufficient  to  obtain  the  rapid  extinction  of 
any  epidemic  if  our  methods  were  perfect.  However,  it  is  proper  for  us  to  bear 
in  mind  what  generally  happens  during  a  prophylactic  campaign  against  yellow 
fever,  and  then  it  will  be  seen  that,  without  doubt  the  purpose  has  always  been 
to  attend  to  two  things  at  the  same  time ;  but  in  the  acute  period  of  the  epidemic, 
when  the  clamor  of  the  people  is  heard  in  all  places  expecting  and  demanding 
immediate  results,  the  general  practice  has  been  to  devote  the  greatest  energy 
to  the  treatment  of  the  material  infected,  leaving  as  a  secondary  consideration 
the  work  of  the  extinction  of  the  breeding  of  stegomyas. 

The  material  infected,  the  patient  and  the  mosquitoes  which  have  bitten 
him  resemble  somewhat  the  firing  line  of  an  advancing  enemy  against  whom  one 
hastens  to  direct  his  fire  before  going  in  a  roundabout  course  and  cutting  off 
the  communication  of  the  enemy  with  his  stores  of  ammunition. 

When  the  Government  of  Intervention  took  charge  of  the  direction  of  our 
affairs  in  the  fall  of  1906,  when  we  were  in  the  midst  of  an  energetic  campaign 
against  yellow  fever,  it  happened  that  Major  Keane,  Sanitary  Supervisor,  demon- 
strated that  the  inspection  of  the  water  reservoirs,  the  destruction  of  the  larvae, 
and  the  general  campaign  against  the  stegomya  had  been  neglected.  It  then 
became  evidently  advisable  that  Major  Keane  should  have  imparted  the  necessary 
activity  to  that  section  of  the  sanitation  work. 

The  same  happened  during  the  recent  epidemic  at  Cienfuegos,  where  the 
greatest  possible  attention  has  been  given  to  the  breeding  places  of  mosquitoes, 
the  strictest  orders  have  been  issued,  which,  however,  there  is  no  doubt  that 
they  had  already  been  observing  in  some  parts  of  the  city;  but  some  time  was 
required  before  the  people  really  understood  what  is  required  of  them  in  the 
matter  of  deposits  of  water  and  breeding  places  of  larvae.  The  doubts  pre- 
vailing concerning  the  matter  caused  some  delay  in  imposing  of  fines,  which  is 
the  only  way  of  securing  the  co-operation  of  all. 

A  general  inspector  arriving  in  the  midst  of  the  campaign  may,  by  devoting 
his  attention  to  this  part  of  the  program,  efficiently  support  the  efforts  of  the 
chief  in  charge  of  the  work. 

So  far  as  the  technique  of  the  fumigation  is  concerned,  Captain  Thomason 
and  his  assistants  realizing  the  necessity  of  modifying  some  details  have  tried 
new  processes.  There  is  no  doubt  whatever  that  by  means  of  the  system  now 
employed,  the  mosquitoes  are  sometimes  frightened  away  from  the  house  during 
the  preliminary  preparation  for  the  fumigation,  either  by  the  family  taking  down 
pictures,  curtains,  opening  drawers  and  closets  to  take  out  anything  that  might 
be  injured  by  sulphur,  or  by  the  fumigators  themselves  who  shake  in  the  air 
the  strips  of  paper  and  the  rolls  used  to  cover  the  cracks  and  openings  in  the 
walls  and  ceilings.  There  is  danger,  especially  as  to  the  ceilings,  in  the  mosquito 
remaining  outside  of  the  paper.  In  order  to  remedy  this  deficiency,  Captain 
Thomason  has  attempted  to  close  up  the  house  from  the  outside,  roof  and 
everything  else,  with  large  canvas  sheets.  This  method  had  been  employed 
before  in  the  disinfection  of  huts  and  barracks  in  Cuba  as  well  as  in  Mexico, 
but  continued  experience  is  extending  the  application  of  the  system  to  all  kinds 
of  dwellings  and  securing  its  use  in  practice. 

Captain  Thomason  has*  also  insisted  on  the  advantage  of  concentrating  the 
operations  of  a  great  number  of  workers  in  one  single  block  of  houses  in  order 
that  all  of  them  may.  be  fumigated  at  the  same  time,  and  to  prevent  mosquitoes 
from  flying  from  one  house  into  another. 

Something  should  be  said  in  a  report  of  this  character  concerning  the  general 
results  obtained  by  the  processes  which  are  being  employed  in  Cuba.  It  is  of 
course  quite  natural  for  the  mere  lookers-on  to  become  impatient,  and  to 
demand  more  rapid  results,  but  the  impartial  opinion  of  experienced  observers 
will  recognize  that  the  work  which  has  been  done  in  Cuba  in  order  to  combat 
yellow  fever,  both  during  the  present  administration  and  during  that  of  President 
Estrada  Palma  has  been  highly  satisfactory.  During  both  epochs  we  have 
succeeded  in  preventing  yellow  fever  from  assuming,  even  remotely,  the  char- 
acter of  extensive  annual  epidemic  recrudescenses,  which  characterized  them  in 
times  gone  by,  nor  has  it  been  allowed  to  assume  the  serious  epidemic  forms 
which  recently  prevailed  in  New  Laredo,  New  Orleans  and  Pensacola.  The 
differences,  owing  mainly  to  the  comparative  promptness  with  which  the  plan 
of  campaign  is  established  in  Cuba,  because  the  announcement  of  the  exist<m-e 
of  yellow  fever  in  any  locality  does  not  produce  the  public  excitement  that  it 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  169 

produces  in  other  places  where  the  fear  of  such  panic  causes  the  announcement 
of  the  disease  to  be  delayed  as  much  as  possible. 

If  we  compare  the  events  of  the  present  invasion  of  yellow  fever  which 
dates  from  the  fall  of  1905,  with  the  results  obtained  in  1901  by  the  great 
organizer  of  the  prophylactic  system  against  yellow  fever,  Colonel  Gorgas,  we 
should  take  into  consideration  the  difference  of  the  existing  circumstances  in 
both  epochs. 

If  we  except  the  great  difficulty  involved  in  the  creation  of  a  new  organism, 
we  must  admit  that  otherwise,  the  epidemic  situation  which  Dr.  Gorgas  encoun- 
tered at  that  time,  was  much  easier  to  control  than  the  present  situation.  He 
did  not  encounter  the  great  obstacle  we  have  pointed  out  in  another  part  of 
this  report,  namely,  the  infection  in  the  rural  districts.  The  lack  of  initiative, 
the  comparative  stagnation  of  the  currents  of  immigration  had,  at  the  end  of 
the  war,  produced  the  cessation  of  the  so-called  endemic  yellow  fever  in  the 
interior.  Under  such  circumstances,  the  effort  wonderfully  organized  by  Col. 
Gorgas  in  Havana  was  sufficient  to  give  the  death  blow  to  the  infection  of 
yellow  fever  in  the  whole  territory.  His  success  was  only  interrupted  for  a 
moment  by  the  re-infection  from  the  neighboring  city  of  Santiago  de  las  Vegas, 
where  it  immediately  found  the  well  organized  forces  of  Havana. 

During  the  last  two  years,  on  the  contrary,  there  has  been  a  feverish  excite- 
ment in  the  sugar  industry.  Since  1901  the  recuperative  strength  of  the 
country  has  been  manifesting  itself  in  a  wonderful  way.  Great  centers  of  culti- 
vation have  been  created  and  many  large  groups  of  immigrants  travel  through 
the  country  or  form  villages  in  the  neighborhood  of  the  great  central  sugar 
plantations. 

Another  current  of  immigrants  is  directed  to  the  network  of  roads  now, 
under  construction,  both  day  laborers  and  stone-cutters  of  said  roads  estab- 
lished their  camps  everywhere.  This  unexpected  movement  drags  the  disease 
to  barn  yards  and  public  roads  like  the  ebb  and  flow  of  the  tide,  and  from  the 
city  to  the  rural  districts,  and  from  the  latter  again  to  the  centers  of  population 
and  open  ports. 

The  present  invasion  of  yellow  fever  heretofore  presents  a  favorable  aspect. 
Up  to  the  present  date  the  epidemic  which  we  have  been  describing  in  this  report 
has  been  a  disease  among  laborers,  or  rather  among  immigrants,  as  it  follows 
in  the  wake  of  workingmen  and  recently  arrived  employees.  Now,  then,  this 
class  of  the  population  tends  to  congregate  by  forming  groups  which  do  not 
introduce  themselves  freely  among  the  Cuban  families,  but  rather  put  them- 
selves in  contact  with  the  adult  native  laborers,  black  or  white,  the  majority 
of  whom  are  immune. 

This  prevents  the  infection  from  invading  extensively  the  native  infantile 
population,  among  which  the  prophylactic  campaign  and  the  diagnosis  of  the 
disease  would  be  much  more  difficult  than  the  newly  arrived  Spaniards  who 
constitute  a  considerable  portion  of  the  laborers. 

The  new  organization  which  has  just  been  introduced  in  the  sanitary  depart- 
ment under  which  each  sanitary  local  chief  has,  together  with  an  abundant 
supply  of  means  at  his  disposal,  a  well  defined  responsibility,  will  doubtless 
powerfully  contribute  to  the  final  elimination  of  yellow  fever  in  Cuban  ter- 
ritory. 

REPORT  OF  DR.  JOS£  HORACIO  ESTEVES,  DELEGATE 
FROM  ECUADOR. 

Although  the  sanitary  condition  in  general,  and  especially  that  of  Guayaquil 
the  principal  port  of  Ecuador,  is  still  lacking  in  many  respects,  the  progress  of 
public  hygiene  among  us  has  been  comparatively  considerable,  due  to  the  efforts 
of  the  Government,  and  the  medical  and  charitable  institutions  during  the  last 
years. 

The  Sanitary  Board  of  Guayaquil  is  an  independent  organization,  with  special 
powers  and  funds,  constituted  by  the  General  Superintendent  of  Police,  as  its 
President,  and  seven  physicians  and  a  chemist,  appointed  from  the  most  promi- 
nent ones  of  the  city.  It  is  represented  in  all  ports,  and  its  jurisdiction  extends 
throughout  five  provinces  of  the  coast. 

The  Board  is  provided  with  a  Clayton  apparatus  of  the  largest  type,  with  the 
necessary  steam  launch ;  for  use  in  the  city,  they  have  another  Clayton  apparatus 


I/O  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

of  smaller  type,  for  the  disinfection  of  buildings  and  of  what  we  improperly  call 
the  sewer  system. 

The  Board  is  provided  with  two  large  formol  generators  of  American  make, 
twelve  fumigators  for  solutions  of  sublimate  and  a  large  Autoclave  for  the  dis- 
infection of  furniture. 

The  Board  has  also  a  provisional  lazaretto,  west  of  the  city,  and  has  adopted 
sanitary  regulations  and  codes  which  are  in  conformity  with  the  Convention  of 
Washington. 

Besides,  the  several  charitable  institutions  established  in  Guayaquil  co-operate 
with  the  Board  and  are  .in  charge  of  the  public  and  private  hospitals,  asylums, 
founding  houses,  insane  asylums,  lazaretto  for  consumptives,  institution  of  animal 
vaccine,  etc.,  etc. 

The  Board  of  Municipal  Charities,  which  renders  very  valuable  services,  pro- 
poses to  request  of  Congress  in  its  next  session  the  passage  of  an  act  making 
vaccination  vvith  animal  vaccine  compulsory. 

The  situation  of  Guayaquil  and  its  suburbs,  in  lowlands  which  are  subject  to 
overflows,  is  the  cause  for  the  presence  of  malaria  in  this  vast  tropical  region, 
not  only  during  the  rainy  season  lasting  from  December  till  April,  but  also 
during  the  dry  season.  In  order  to  quench  the  disease,  the  most  efficient  meas- 
ures are  being  carried  out,  draining  swamp,  and  filling  with  petroleum  and  tar 
all  places  containing  stanched  waters. 

I  must  also  mention  in  this  brief  report  the  great  projected  work  which  will 
soon  be  carried  out,  that  of  the  canalization  of  Guayaquil,  for  which  an  appro- 
priation of  12,000,000  pesos  (about  $6,000,000)  has  been  made.  This  is  an  indis- 
pensable improvement  for  the  sanitation  of  that  important  port,  and  its  realiza- 
tion will  be  the  basis  of  all  scientific  works,  the  carrying  out  of  which  is  at 
present  impossible,  for  the  definite  eradication  of  yellow  fever,  and  malaria, 
which  is  there  endemic  under  all  its  forms. 

Much  has  already  been  accomplished  for  the  city  with  the  realization  of  the 
water  supply  which  is  carried  to  the  city  by  means  of  iron  conduits,  from  a  dis- 
tance of  many  miles  and  through  the  Gulf  of  Guayaquil.  Thanks  to  this  im- 
provement, carried  out  by  the  Municipality,  the  sanitary  conditions  of  Guayaquil 
are  now  more  favorable ;  but  much  remains  yet  to  be  done  in  order  to  give  to 
that  important  port  on  the  Pacific  the  habitable  conditions  required  in  a  perfect 
city. 

Guayaquil  is  a  beautiful  city  located  on  the  right  bank  of  the  River  Guayas, 
and  has  now  a  population  of  90,000  inhabitants,  in  spite  of  the  fact  that  it  has 
been  ravaged  by  fires  on  different  occasions.  In  the  center  of  several  provinces, 
it  is  very  important  on  account  of  its  commerce,  and  still  more  on  account  of 
its  agricultural  wealth,  its  production  of  cacao  being  equal  to  two-thirds  of  the 
total  world's  output. 

One  of  the  great  works  which  will  soon  be  finished,  and  of  which  I  wish  to 
make  special  mention,  is  that  of  the  Rocafuerte  Sanatorium  in  Quito,  the  capital 
of  the  Republic,  which  comprises  several  magnificent  buildings,  distributed  ac- 
cording to  the  most  recommended  hygienic  rules,  and  which  will  be  devoted  to 
the  exclusive  attendance  of  consumptives.  The  climate  of  Quito  is  most  bene- 
ficial to  the  treatment  of  the  disease,  the  temperature  being  12°  centigrade,  and 
the  altitude  2,850  meters  above  the  level  of  the  sea.  When  this  sanatorium  is 
completed  it  will  be  one  of  the  best  establishments  of  its  kind  in  the  world,  if  it 
will  not  excel  them. 

Water  and  sewer  works  are  also  being  carried  out  in  the  capital  of  the 
Republic,  and  in  the  provinces  of  the  Chimborazo  and  Oro. 

Malaria  has  its  principal  foci  in  the  province  of  Esmeraldas,  in  the  central  and 
northern  parts  of  Manabi,  in  the  greater  part  of  the  Province  of  Manabi,  and  in 
the  provinces  of  Los  Rios  and  El  Oro;  of  the  interior  provinces,  only  those  of 
Chimborazo  are  free  from  malaria.  To  eradicate  this  disease  in  the  rural  towns 
of  the  mountain  regions  would  be  an  almost  impossible  task,  but  the  National 
Government,  the  municipalities,  and  the  scientific  and  charitable  institutions  are 
working  together  for  the  purpose  of  improving  in  the  best  possible  way  the  san- 
itation of  the  principal  centers  of  population,  and  to  destroy  the  mosquitoes  that 
transmit  the  disease. 

Trachoma,  beriberi,  and  bubonic  plague  are  totally  unknown  in  Ecuador;  the 
latter  disease  invaded  the  border  province  of  Piura,  Peru,  but  it  did  not  pass 
into  our  country,  due  to  persevering  efforts  of  Board  of  Health,  which  established 
maritime  and  land  quarantines.  To  this  end,  there  established  in  1903,  in  the 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  I/I 

Island  of  Puna,  a  sanitary  station,  fully  equipped,  and  under  the  immediate 
charge  of  a  physician. 

Smallpox  appears  occasionally  in  a  benign  form,  never  assuming  the  propor- 
tions of  true  epidemic,  and  only  among  those  who  have  not  been  vaccinated. 

To  contribute  to  the  improvement  of  hygiene  in  our  country,  the  delegation 
from  Ecuador  will  convey  thereto  the  practical  lessons  which  necessarily  will  be 
derived  from  this  Sanitary  Convention. 


REPORT  OF  DRS.  SALVADOR  ORTEGA  AND  JUAN 
AZURDIA,  DELEGATES  FROM  GUATEMALA. 

The  Guatemalan  Republic,  by  invitation  of  the  International  Sanitary  Office 
of  Washington,  courteously  given  by  the  Government  of  the  United  States  of 
Mexico,  comes  to  the  Third  Sanitary  Pan- American  Convention  through  the 
undersigned  delegates  who  have  the  honor  of  representing  their  own  country. 

The  Republic  of  Guatemala  has  entered  into  that  sanitary  movement,  im- 
posed by  the  necessities  of  mercantile  intercourse  and  demanded  by  the  advances 
which  public  and  private  hygiene  win  from  day  to  day. 

For  this  purpose  it  promulgated  in  May  of  1906  its  Code  of  Health,  based  upon 
everything  new,  that  the  legislators  could  find  applicable  to  the  conditions  of  the 
people  who  constitute  that  country. 

It  also  subscribed  to  the  Convention  of  Washington,  an  adhesion  warmly 
recommended  to  the  countries  which  have  not  subscribed  to  it,  by  the  2d  Pan- 
American  International  Conference. 

In  that  Code  and  in  that  Convention  figure  all  the  practical  recommendations 
which  must  be  developed  in  the  Republic,  for  national  and  international  security 
in  sanitary  affairs,  whether  in  the  domain  of  prevention  or  in  that  of  combating 
the  pest,  cholera,  or  yellow  fever. 

Our  scarce  relations  with  the  countries  scourged  by  the  bubonic  fever  have 
sheltered  us  against  its  invasion.  The  pest  of  the  Orient  has  never  penetrated 
among  us. 

The  Asiatic  Cholera  Morbus  was  imported  into  the  national  territory  in  1857. 
It  has  never  appeared  again  in  the  country. 

The  last  epidemic  of  black  vomit  presented  itself  in  the  Department  of 
Zacapa,  in  the  eastern  part  of  the  Republic,  in  August  and  September  of  1905. 

It  entered  by  the  northern  coast,  on  the  Atlantic  shore,  imported  from  Belize 
to  Honduras  and  from  Honduras  to  Livingston,  whence  it  penetrated  into 
Zacapa  and  scourged  that  town,  the  seat  of  government  of  the  Department  of 
the  same  name. 

In  the  year  1900  we  had  an  epidemic  of  small-pox,  which  propagated  itself 
through  all  the  Republic,  producing  numerous  victims,  and  since  that  time  it  has 
not  again  appeared. 

The  exanthematic  typhus  has  penetrated  through  the  frontiers  which  bound 
us  with  the  Mexican  Republic,  invading  the  Departments:  San  Marcos,  Quezal- 
tenango,  Suchitepequez,  Totonicapam,  Solola,  Quiche,  Chimaltenango,  Sacate- 
pequez  and  Guatemala,  in  a  slow,  gradual  invasion  which  lasted  from  1897  until 
the  beginning  of  the  present  year,  having  almost  completely  disappeared;  since 
the  statistics  of  the  capital  during  the  last  six  months  give  but  one  case  in  the 
Hospital  for  Epidemics. 

Malaria,  in  all  their  kinds,  is  observed  in  the  coasts  of  both  seas.  It  disap- 
pears in  dry  season,  and  reappears  again  at  the  beginning  and  conclusion  of 
raining  season. 

In  order  to  avoid  it,  is  made  in  .Puerto  Barrios  in  the  Atlantic  coast,  the  sys- 
tematic petrolization  of  swamp  waters ;  and  in  San  Jose,  a  port  on  Pacific  Ocean, 
is  made  too,  in  little  scale,  the  necessary  drainage. 

These  two  ports,  which  are  the  most  important  populations  on  both  seas,  will 
be  opportunely  fixed,  according  with  the  projects  that  the  Government  has  in 
study  for  it. 

Our  medical  statistics  and  the  data  which  we  have  acquired  from  the  physicians 
of  the  Republic,  have  not  demonstrated  to  us  the  existence  of  trachoma  in  our 
territory.  As  much  can  be  said  of  beri-beri. 


172  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

To  prevent  the  invasion  of  infectious,  contagious  and  epidemic  diseases,  there 
have  been  decreed  from  1905,  the  following  legal  dispositions: 

Code  of  Health  and  the  laws  and  regulations  from  it  deduced. 

Law  of  Sanitary  Police. 

Law  as  to  obligatory  declaration  of  infecto-contagious  diseases,  and  the  dis- 
infection of  places  and  objects  contaminated. 

Regulations  of  dairies. 

Regulation  of  slaughter  houses  and  slaughterers. 

Regulations   of  bakeries. 

Regulation  of  butchershops. 

There  has  been  created  in  the  capital,  the  National  Disinfectory,  which  has : 

A  Chief.* 

A  Secretary. 

An  Inspector. 

A  corps  of  disinfectors  and  the  following  apparatus  and  fixtures: 

One  medium,  fixed  Geneste  Herscher  oven. 

Four  pulverizers  for  solutions  of  bi-chloride,  of  German  model. 

Four  pulverizers  for  formaline. 

Two  pulverizers  for  bi-chloride  solution,  French  model. 

Two  apparatus  for  whitewashing. 

And  the  accessories  for  home  disinfection,  such  as  wagon  for  infected  and 
disinfected  objects,  etc.,  etc. 

There  has  been  also  created  the  institute  for  animal  vaccine  in  the  capital  of 
the  Republic  with  the  following  dependences : 

Room  for  the  examination  of  animals. 

Room  for  the  preparation  of  the  same. 

Room  for  operations. 

Stable  for  those  inoculated  and  not  inoculated. 

Room  for  autopsies. 

Sleeping  room  for  the  warden. 

Microbiological  laboratory. 

Packing  and  distribution  department. 

Archive. 

It  is  provided  with  the  necessary  instruments  and  with  the  following  personnel : 

One  Director. 

Two  practitioners. 

One  Chief  of  Laboratory. 

One  servant  man. 

One  Warden. 

This  Institute  was  founded  in  1902  as  an  adjunct  to  the  Military  Hospital, 
"but  has  now  a  building  of  its  own  of  modern  style,  abounding  in  gardens  and 
situated  on  one  of  the  principal  avenues  of  the  capital. 

Vaccination  is  obligatory  for  every  person,  according  to  a  law  promulgated 
in  the  year  1883.  Never  is  made  from  arm  to  arm. 

There  has  also  been  established  a  "Hospital  for  Epidemics,"  that  is,  an  es- 
tablishment for  isolation,  beyond  the  limits  of  the  City  of  Guatemala,  for  all 
sick  people  attacked  by  infecto-contagious  diseases  and  another  at  the  city  of 
Quezaltenango. 

For  study  of,  vigilance  over,  and  development  of  all  affairs  relating  to  public 
health,  there  was  created  the  Superior  Board  of  Health. 

It  has  already  dictated  measures  pertaining  to  the  purpose  of  its  institution, 
and  is  working  to  resolve  all  the  problems  which  relate  to  the  practice  of  the 
stipulations  of  the  Convention  of  Washington. 

The  Supreme  Government,  to  fulfill  the  stipulations  referred  to,  has  under 
study  the  projects  upon : 

The  creation  of  the  Sanitary  Station  of  Puerto  Barrios,  and  that  of  the  Puerto 
of  San  Jose. 

It  has  also  in  project  the  creation  m  the  capital  of  a  crematory  for  sweeping 
and  rubbish,  and  a  complete  slaughtering  house. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  173 

REPORT  OF  DR.  LUIS  LAZO  ARRIAGA,  DELEGATE  OF 

HONDURAS. 

Having  been  appointed  by  the  Government  of  Honduras  as  a  delegate  to  this 
Congress,  I  request  your  kind  attention  for  a  few  moments. 

The  late  politico-economic  conditions  of  Honduras  have  prevented  her  from 
carrying  on  the  sanitation  works  begun  on  the  Atlantic  coast.  The  Government 
I  represent  is  convinced  that  the  disease  which  causes  the  greatest  ravages 
in  the  country  is  malaria,  and  hence  its  principal  efforts  are  directed  to  the 
drying  of  the  swamps  on  our  coast. 

I  hope  that  before  long  the  results  obtained  may  be  communicated  to  this 
Congress. 

The  picturesque  port  of  Amapala,  situated  on  Isla  del  Tigre  (Tiger  Island), 
on  the  Gulf  of  Fonseca,  used  to  be  frequently  ravaged  by  yellow  fever;  but  as 
the  only  stagnant  waters  on  the  island  are  those  contained  in  a  small  pond 
formed  from  rainwater,  it  was  easy  for  the  health  authorities  of  the  aforesaid 
port  to  cover  said  water  with  a  thin  coating  of  common  oil,  or  petroleum, 
during  the  dry  season,  and  by  this  means  black  vomit,  or  yellow  fever,  disap- 
peared many  years  ago  from  our  Pacific  port. 

The  same  is  not  true  of  the  Atlantic  ports ;  but  the  strict  quarantine  measures 
adopted  in  co-operation  with  the  sanitary  authorities  of  New  Orleans  last  year, 
prevented  the  introduction  of  these  diseases  on  our  coasts. 

As  an  epidemic  smallpox  has  disappeared  almost  entirely  from  the  country, 
thanks  to  compulsory  vaccination,  and  whenever  cases  occur  they  are  immediately 
isolated,  and  preventive  vaccination  is  resorted  to. 

Tuberculosis  is  a  disease  that  weighs  but  little  in  the  sanitary  balance  of  the 
people  of  Honduras,  so  much  so  that  the  death  rate  caused  by  this  disease  does 
not  exceed  one  per  thousand. 

The  small  density  of  population,  the  great  abundance  of  pine  trees  in  our 
fields,  the  profusion  of  solar  light  and  pure  air,  are  no  doubt  the  reasons  why 
Honduras  is  unfavorable  to  the  spread  of  tuberculosis. 

Cholera,  the  bubonic  plague,  trachoma,  and  beri-beri  are  entirely  unknown  in 
Honduras. 

REPORT  OF  THE  DELEGATION  FROM  MEXICO. 

YELLOW  FEVER. 

We  have  the  pleasure  of  declaring  to  this  Convention  that  in  no  part  of  the 
National  Territory  is  there  any  epidemic  of  yellow  fever;  that  in  the  course 
of  the  present  year  only  five  cases  have  been  reported,  in  a  small  village  called 
Paraje  Nuevo,  in  the  Canton  of  Cordoba  and  State  of  Veracruz.  Of  these  two 
cases  one  was  taken  to  Veracruz  on  suspicion  and  there  confirmed  on  the  7th 
of  February  of  this  year.  He  was  properly  isolated,  but  succumbed  on  the  pth 
of  that  month.  Two  cases  were  reported  in  Merida  on  the  iQth  and  2ist  of 
March,  and  another  case,  which  was  very  doubtful,  was  reported  in  Veracruz 
on  the  5th  of  September  last,  which  two  local  physicians  diagnosed  as  yellow 
fever,  whilst  two  others  of  the  same  locality  were  not  of  the  same  opinion. 

As  can  be  seen,  these  cases  were  of  a  sporadic  character  and  in  no  part  of 
the  Republic  has  there  been  anything  like  an  epidemic. 

This  result  is  highly  satisfactory  and  is  a  further  proof  that  the  methods  adopted 
in  Mexico  will  obtain  the  final  disappearance  of  that  fearful  disease  from  our 
territory.  It  is  very  true  that  we  have  adopted  methods  which  differ  from  those 
generally  followed  in  other  tropical  countries,  by  continuing  our  campaigning 
even  during  the  winter,  and  by  not  making  any  modifications  at  any  time  what- 
ever in  the  services  which  are  carried  on  in  those  places  that  have  for  centuries 
been  the  foci  of  endemia:  Veracruz  and  Merida. 

In  the  former  city,  the  service  is  carried  on  by  dividing  It  into  four  different 
districts,  each  under  the  charge  and  supervision  of  a  physician  with  27  agents 
and  19  servants  under  his  orders,  as  well  as  an  engineer  who  is  specially  em- 
ployed in  the  drainage  of  all  swamps  which  may  be  formed,  in  the  filling  up  of 
the  hollows  in  which  pools  of  water  may  accumulate,  and  if  this  cannot  be  done, 
in  spreading  a  thin  layer  of  oil  over  the  water.  This  engineer  also  looks  after 
the  connections  between  the  house  drains  and  the  sewerage  system  of  the 


174  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

city.  The  rest  of  the  staff  is  occupied  in  forming  the  schedule  of  the  non-immunes 
who  may  be  found  in  each  district  so  that  they  may  be  visited  every  day  and 
discovered  at  the  moment  when  any  one  of  them  falls  sick,  in  order  that  such 
patient  may  at  once  be  carried  to  an  isolated  ward.  At  the  same  time  that  the 
staff  makes  its  visit  to  every  house  it  inspects  the  water  system  (cisterns  or  tanks) 
and  if  they  are  found  to  contain  larvae  they  are  emptied,  the  larvae  destroyed, 
the  water  renewed,  and  the  owners  are  made  to  cover  the  deposit  with  a  proper 
cover  or  a  layer  of  oil  is  spread  on  the  surface. 

Whilst  all  these  services  are  carried  on,  measures  have  been  taken  to  improve 
the  sanitary  conditions  of  the  city;  suitable  works  have  been  executed  for  the 
supply  of  drinking  water,  with  a  network  of  sewers  to  carry  the  refuse  out  to 
sea,  and  other  works  are  in  course  of  construction  to  carry  off  the  surface  water 
and  to  lay  first  class  pavement  throughout  the  city.  When  these  last  two  works 
are  completed  the  sanitary  condition  of  the  port  will  be  notably  improved. 

In  Merida,  the  city  is  also  divided  into  four  districts,  each  under  the  charge 
of  a  physician,  under  whom  are  28  agents  and  38  servants,  who  carry  on  a 
similar  service-  to  that  above  described  with  respect  to  Veracruz.  The  city  of 
Merida  is  distinguished  for  its  cleanliness,  the  streets  are  paved  with  sheet 
asphalt;  the  houses  are  all  very  clean,  and  even  in  the  poorest  of  the  laboring 
class,  they  have  carried  their  personal  cleanliness  to  a  height  which  is  hardly 
ever  found  in  any  other  city. 

In  Progreso  the  service  is  carried  on  by  a  physician  and  two  agents,  whose 
labors  are  dedicated  to  the  same  purpose  as  above  indicated. 

In  order  to  attend  to  any  sporadic  case  of  yellow  fever  which  may  be  observed 
in  any  of  the  towns  that  in  former  times  have  been  invaded  by  this  disease, 
three  Flying  Brigades  have  been  organized. 

One  of  these  has  its  headquarters  in  Cordoba  where  the  Mexican  Railroad 
(from  Mexico  to  Vera  Cruz)  connects  with  the  Vera  Cruz  and  Pacific  R.  R. 
and  its  sphere  of  action  extends  to  Santa  Lucrecia  on  the  one  side  to  Vera  Cruz 
on  the  other,  and  on  the  South  as  far  as  the  Valle  Nacional,  as  shown  by  the 
territory  indicated  with  a  fed  line  on  the  plans  herewith  presented. 

The  second  brigade  has  its  headquarters  in  Coatzacoalcos,  and  its  radius  of 
action  extends  to  Sta.  Lucrecia,  thus  including  the  two  counties  of  Vera  Cruz 
which  are  indicated  by  a  blue  line  on  the  map. 

The  third  brigade  has  its  headquarters  in  Salina  Cruz  and  operates  as  far  as 
Sta.  Lucrecia  where  the  Vera  Cruz  and  Pacific  R.  R.  connects  with  the  Tehuan- 
tepec  National,  thus  covering  a  territory  which  is  indicated  by  a  green  line. 

The  methods  by  which  these  brigades  work  is  as  follows:  The  Supreme  Board 
of  Health  daily  receives  a  report  on  the  sanitary  conditions  of  the  different  towns 
with  the  following  data: 

New  cases  observed  on  the  date  of  the  report. 

Total  number  of  cases  from  the  first  day  of  the  year. 

Number  of  cases  discharged  on  the  date  of  the  report. 

Deaths  on  the  date  of  the  report. 

Total  number  of  deaths  from  the  first  of  the  year. 

New  foci  of  infection  on  the  date  of  the  report. 

Total  number  of  foci  discovered  from  the  first  of  the  year. 

Cases  confirmed  and  subjected  to  treatment. 

Suspected  cases  isolated  on  the  date  of  the  report. 

Domiciliary  visits  made  to  dwellings  of  immunes. 

Dwellings  of  non-immunes  visited  to  ascertain  whether  anyone  is  suffering 
from  fever. 

Reports  of  train  inspectors. 

Water  tanks  or  cisterns  emptied. 

Water  tanks  or  cisterns  covered  with  oil. 

Wells  covered  with  oil. 

As  the  above  reports  are  sent  daily  by  telegraph  the  Board  at  once  knows 
where  a  suspected  case  of  sickness  has  been  found  and  the  Chief  of  the  re- 
spective Flying  Brigade  is  ordered  to  proceed  there  with  a  part  of  his  staff, 
and  the  necessary  utensils  to  disinfect  the  premises  as  well  as  a  sufficient  quan- 
tity of  oil  to  cover  the  water  tanks.  The  suspected  patient  is  isolated,  the  house 
in  which  he  has  lived  is  disinfected,  as  well  as  the  neighboring  houses  and  a 
domiciliary  visit  is  made  so  as  to  discover  whether  anybody  else  is  sick. 

As  cases  have  been  found  and  may  again  be  found  of  persons  who  are  suffer- 
ing or  suspected  of  suffering  from  yellow  fever,  traveling  on  the  railroad  trains, 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  175 

a  sanitary  agent  travels  in  every  train  and  takes  notes  of  all  the  passengers,  tak- 
ing their  names  and  place  of  destination.  If  any  person  is  found  sick  but  able 
to  continue  his  journey  seated,  he  is  covered  with  a  hat  and  veil  of  the  form  present- 
ed herewith.  If  he  cannot  continue  seated,  he  is  covered  with  another  veil,  of  the 
form  presented  herewith,  and  when  he  reaches  his  destination,  he  is  turned  over 
to  the  chief  sanitary  officer  of  the  locality  in  order  that  he  may  be  isolated. 
This  service  is  carried  on  in  all  the  trains  running  through  the  zones  that,  in 
previous  periods,  have  been  invaded  by  yellow  fever. 

If  focus  of  yellow  fever  should  be  discovered  in  any  place  within  the  dis- 
tricts shown  on  the  map,  the  Flying  Brigade  at  once  proceeds  there,  and  if  there 
is  any  lazaretto  or  hospital,  the  patient  is  isolated  therein,  whilst  if  there  is 
none,  a  provisional  portable  hospital  is  erected  in  accordance  with  the  model  now 
presented. 

As  the  States  in  which  yellow  fever  has  appeared,  not  only  contribute  out  of 
their  own  resources  to  the  maintenance  of  the  service  above  described,  but  have 
also  transferred  their  authority  and  powers  to  the  Federal  Government,  there  is 
only  one  central  authority  in  the  City  of  Mexico,  and  it  is  this  which,  by 
means  of  the  telegraph,  controls  the  service  of  these  Brigades,  and  thus  can  take 
timely  action  in  any  emergency  which  may  arise. 

We  believe  that  if  all  the  nations  of  the  Western  Hemisphere  within  whose 
territory  yellow  fever  prevails,  would  establish  a  service  similar  to  that  which 
has  been  so  successful  in  the  Mexican  Republic,  we  could  feel  certain  that  within 
the  near  future  this  disease  would  disappear  from  the  face  of  the  earth. 

As  it  is  the  duty  of  the  Mexican  Delegation  to  indicate  the  transmissible  dis- 
eases which  prevail  in  this  Republic,  and  it  has  no  exact  figures  available  which 
would  show  the  frequency  of  malaria,  on  account  of  the  difficulties  which  attend 
the  collection  of  these  data,  the  present  report  is  limited  to  a  map  which  shows 
the  geographical  distribution  and  comparative  frequency  of  the  disease  in  the 
different  States  of  the  Republic.  It  is  difficult  to  obtain  these  data  because  in 
cases  of  chronic  malaria,  the  patients  are  not  confined  to  their  beds,  nor  do  they 
give  any  notice  of  the  existence  of  the  disease.  Nor  can  any  consideration 
be  given  to  the  mortality  returns,  because  this  disease  does  not  directly  result 
in  death,  except  in  cases  of  pernicious  fever,  and  malarial  anemia,  which  predis- 
pose the  patient  to  contract  other  fatal  disease,  it  does  not  figure,  amongst  the 
causes  of  death. 

As  regards  malaria,  we  already  know  the  germ  which  produces  it,  the  agent 
which  transmits  it  and  the  method  of  curing  it,  but  nevertheless,  we  find  it  scat- 
tered through  such  extensive  territories  and  amongst  so  many  different  peoples, 
that  we  can  only  wonder  that  it  has  no{  been  as  yet  extinguished. 

The  fact  is  that  the  scientific  problem  is  very  simple,  but  the  practice  is  very 
complicated.  In  fact,  the  spread  of  the  disease  requires  three  factors,  as  follows: 

A  patient  suffering  from  malaria. 

An  anopheles  mosquito  to  sting  him,  and 

A  predisposed  person  to  receive  the  inoculation  from  that  mosquito. 

Theoretically  the  problem  is  resolved  by  disassociating  the  two  first  factors, 
or  by  conferring  immunity  on  healthy  persons. 

In  fact,  if  we  isolate  the  patient  in  rooms  whose  doors  and  windows  are 
covered  with  wire  netting,  the  mosquito  can  not  get  in  to  sting  him. 

If  we  could  destroy  all  the  mosquitoes  of  the  genus  "anopheles,"  there  would 
be  no  agent  to  transmit  the  disease  from  the  sick  to  the  healthy  man. 

And  lastly,  if  we  could  confer  immunity  on  healthy  persons,  the  propagation 
of  malaria  would  be  impossible. 

But  these  resources,  which  are  so  simple  in  expression,  find  great  difficulties 
in  their  application,  which  we  will  try  to  set  forth  in  order  to  study  the  methods 
for  overcoming  them. 

In  diseases  which  assume  an  acute  form,  the  patient,  finding  himself  obliged 
to  take  to  his  bed,  gives  himself  up,  so  to  speak,  to  the  sanitary  authorities; 
and  this  is  what  takes  place  in  cases  of  bubonic  plague,  cholera,  yellow  fever, 
scarletina,  measles,  typhus,  etc.  But  those  who  suffer  from  malaria,  unless 
in  the  pernicious  or  ordinary  acute  form,  are  not  confined  to  their  beds; 
they  go  in  and  out  of  their  houses,  attend  to  their  ordinary  occupations,  do  n6t 
consult  a  physician,  and  therefore  do  not  come  under  the  supervision  of  the 
sanitary  authorities  until  the  disease  assumes  an  acute  form,  but  as  these 
patients  who  suffer  from  the  chronic  form  are  liable  to  be  stung  by  mosquitoes 
which  are  thereby  infected,  they  are  as  much  a  source  of  danger  as  those  who 


176  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

suffer  from  the  acute  form,  whilst  on  the  other  hand,  as  they  are  so  numerous 
in  marshy  countries,  it  is  almost  impossible  to  submit  them  to  isolation,  which 
if  possible  would  be  a  measure  of  unquestionable  efficiency,  as  it  is  with  regard 
to  yellow  fever. 

The  second  resource  would  be  the  extinction  of  the  mosquitoes  of  the  genus 
"anopheles."  This  work  has  been  undertaken  with  great  success  in  some  parts, 
as  for  instance  in  Ismailia,  where  it  was  tried  for  the  first  time,  and  by  ourselves 
on  the  "Eldorado,"  State  of  Sinaloa,  as  well  as  in  all  other  places  where  we 
had  special  services  for  the  suppression  of  yellow  fever.  This  method  consists 
in  the  extermination  of  the  larvae  of  the  mosquitoes,  wherever  they  are  dis- 
covered in  water  tanks  or  pools  where  the  females  deposit  their  eggs. 

But  if  it  is  a  question  of  such  large  areas  as  those  in  our  territory  which  are 
occupied  by  immense  swamps  in  which  the  mosquitoes  breed  in  fabulous  num- 
bers, the  resources  which  are  available  and  practical  in  the  cities  become  imprac- 
ticable in  such  an  enormous  scale. 

There  are  still  other  resources,  of  which  the  principal  consists  in  the  drainage 
of  marshy  lands  or  the  spreading  of  oil  over  the  waters.  The  first  of  these 
methods  has  been  carried  out  in  England  with  success  for  many  years  back. 
The  marshes  are  made  to  disappear  either  by  drainage  or  by  filling  up;  but  this 
method,  although  really  efficacious  is  slow  and  very  expensive  when  the  marshes 
cover  a  large  area. 

As  regards  smaller  areas  of  water,  we  have  the  resource  which  is  always 
very  effective,  of  covering  them  with  a  thin  layer  of  petroleum.  This  method 
is  that  which  we  are  now  employing  in  Merida,  Progreso,  Coatzacoalcos,  Vera 
Cruz  and  Tampico  along  the  Gulf  Coast,  and  in  Salina  Cruz  on  the  Pacific 
Coast.  For  the  last  four  years  our  Government  has  appropriated  large  sums  to 
the  campaign  against  yellow  fever  and  malaria,  and  these  funds  are  employed 
over  all  the  zone  of  the  State  of  Vera  Cruz  which  is  included  between  Cordoba 
and  Santa  Lucrecia,  and  on  the  Isthmus  of  Tehuantepec. 

When  we  have  been  able  to  extinguish  yellow  fever,  the  numerous  staff  that 
we  now  have  employed  in  that  campaign  will  go  from  district  to  district,  execut- 
ing the  same  efficient  work  which  has  been  carried  out  in  the  places  above 
named  during  the  last  four  years. 

The  other  resources  which  we  have  at  our  disposal  through  our  knowledge 
of  the  germ  of  the  disease  and  its  methods  of  transmission,  is  that  of  procuring 
the  immunity  of  the  persons  who  may  have  to  expose  themselves  to  the  sting 
of  infected  mosquitoes.  The  means  which  are  at  present  available  consist  in 
the  administration  of  the  salts  of  quinine,  which  is  both  preventive  and  cura- 
tive. The  experience  acquired  in  Italy,  in  those  parts  of  Africa  where  these  salts 
have  been  employed,  and  in  our  own  country,  have  demonstrated  the  efficiency 
of  this  method,  and  we  propose  to  employ  it  on  a  larger  scale  under  the  super- 
vision of  the  brigades  which  are  now  almost  exclusively  employed  in  the 
struggle  against  yellow  fever.  But  in  order  to  make  the  struggle  against  ma- 
larial fevers  really  effective  and  to  convert  it  into  a  universal  resource,  it  is 
necessary  for  us  to  preach  by  means  of  books,  of  the  scientific  and  general  press, 
and  of  lectures,  the  doctrine  of  the  transmission  of  malaria  and  the  powerful 
resources  which  are  available  against  it,  and  not  leave  this  task  to  the  exclusive 
attention  of  the  authorities. 

I,  therefore,  propose  to  this  Honorable  Convention  that  we  should  commence 
a  crusade  against  malaria  similar  to  that  which  we  have  already  undertaken 
against  tuberculosis.  If  we  can  convince  every  man  of  the  dangers  offered  by 
swampy  countries,  and  that  it  is  within  his  power  to  take  precautions  against 
the  sting  of  the  mosquito;  if  we  inculcate  in  him  the  prudence  of  sleeping 
under  a  mosquito  net,  of  having  the  doors  and  windows  in  his  dwelling 
provided  with  screens  that  will  prevent  the  entrance  of  the  mosquito;  if  we  can 
teach  him  to  cover  the  pools  of  water  which  cannot  be  drained  or  levelled  up, 
with  oil;  if  we  accustom  him  to  use  small  quantities  of  quinine  which  will  afford 
him  protection  when  he  cannot  have  that  of  the  gauze  curtains  or  screened 
doors  and  windows,  we  will  convert  each  man  into  a  co-operator  in  this  great 
task. 

I  come  to  propose  the  adoption  of  these  methods  after  having  seen  the  prac- 
tical and  good  results  that  they  have  given  in  our  campaign  against  yellow  fever, 
and  also  in  view  of  the  experience  that  we  have  acquired,  even  though  on  a 
small  scale,  in  the  "Eldorado,"  property  in  the  State  of  Sinaloa. 

The  facilities  of  communication  between  men,  whether  by  land  or  by  sea, 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  177 

have  resulted  in  the  greatest  benefit  to  humanity;  but  as  there  is  no  benefit 
which  is  not  accompanied  by  its  corresponding  evil,  the  same  can  be  said  with 
respect  to  the  facilities  which  are  afforded  by  steamship  and  railroad  trans- 
portation. 

In  moving  from  one  place  to  another,  men  carry  with  them  the  diseases  from 
which  they  may  be  suffering.  The  international  Sanitary  Police  has  displayed 
the  greatest  care,  sometimes  to  a  very  exaggerated  degree,  in  its  endeavors  to 
prevent  transmissible  acute  diseases  from  being  brought  into  the  ports  or 
frontier  cities,  or  in  more  exact  terms,  it  has  endeavored  to  put  every  obstacle 
in  the  way  of  the  transmission  of  those  diseases,  by  detaining  those  persons  who 
are  sick  or  suspected  of  suffering  from  those  diseases,  in  the  ships  by  which  they 
have  been  transported  or  in  special  lazarettes.  But  as  regards  transmissible 
chronic  diseases,  no  notice  has  been  taken  of  them  by  the  legislators  before  the 
present  time,  and  nevertheless  it  is  as  necessary  to  protect  ourselves  from  the 
acute  transmissible  diseases  as  from  those  which  have  a  slow  development  and 
are  therefore  denominated  chronic. 

In  these  days,  when  the  Asiatic  immigration  encounters  such  great  difficulties 
in  its  efforts  to  penetrate  the  United  States  of  America,  its  current  has  been 
turned  towards  the  countries  of  Latin  America.  In  Mexico  we  receive  every 
month  one  or  two  steamers  in  the  port  of  Salina  Cruz,  some  with  Chinese  and 
others  with  Japanese  immigrants. 

Our  Sanitary  Code  provides  that  only  those  persons  will  be  allowed  to  enter 
the  Republic  with  the  character  of  immigrants,  when  they  are  in  possession  of 
certificates  which  prove  their  perfectly  healthy  conditions,  issued  by  the  com- 
petent authority  in  the  place  of  departure  and  viseed  by  the  Mexican  Consul. 
Under  Art.  49  of  that  same  Code,  certificates  which  have  been  issued  two  months 
previously  to  the  date  on  which  the  immigrant  reaches  our  shores  will  be  con- 
sidered null  and  void. 

This  measure  was  found  insufficient  in  practice  because  the  immigrants  might 
have  started  from  their  own  countries  with  the  diseases  in  a  state  of  incubation 
and  reach  our  ports  with  them  already  developed.  It  is  to  be  noted  that  our 
situation  lends  itself  greatly  to  the  transmission  of  disease,  because  the  ships 
do  not  touch  at  any  port  on  their  voyage,  but  come  directly  from  the  Asiatic 
ports  to  ours  on  the  Pacific.  In  view  of  this,  orders  have  been  given  with 
respect  to  Chinese  immigrants,  which  may  be  briefly  summed  up  as  follows : 

The  immigrants  must  come  provided  with  certificates  of  health  issued  by  a 
physician  in  the  port  of  departure  and  viseed  by  the  Mexican  Consul  in  that  port, 
or  in  his  defect,  by  the  United  States  Consul. 

Asiatic  immigrants  can  only  be  allowed  to  land  in  the  port  of  Salina  Cruz, 
if  they  are  more  than  ten  in  number;  but  when  their  number  does  not  exceed 
ten,  they  are  allowed  to  land  in  the  ports  of  Acapulco,  Mazatlan,  Guaymas, 
Tampico,  Vera  Cruz  or  Coatzacoalcos. 

Every  ship  which  transports  immigrants  is  received  in  accordance  with  the 
provisions  of  the  Sanitary  Code,  the  Maritime  Sanitary  Regulations,  and  the 
Special  Ruling  which  may  be  issued  by  the  Supreme  Board  of  Health  in  each 
case  and  in  view  of  the  circumstances. 

If  there  are  none  of  these  special  circumstances  present,  the  healthy  immi- 
grants are  at  once  allowed  to  land  and  are  directly  taken,  over  a  special  wharf, 
to  the  lazarette  which  is  dedicated  to  them. 

In  this  lazarette  they  are  made  to  bathe,  their  clothing  and  baggage  are  dis- 
infected, and  they  are  kept  under  observation  for  a  period  of  ten  days. 

If  at  the  end  of  that  period  no  disease  has  made  its  appearance  amongst  them, 
they  are  permitted  to  leave,  but  also  required  to  report  to  the  delegate  of  the 
Supreme  Board  of  Health,  the  point  to  which  each  immigrant  proposes  to  travel. 

Up  to  the  present  these  measures  have  been  sufficient  to  keep  us  free  from 
cholera,  bubonic  plague  and  yellow  fever;  but  they  have  not  prevented  the  in- 
troduction into  the  country,  which  has  actually  taken  place,  of  persons  suffer- 
ing from  beri  beri.  As  this  disease  was  entirely  unknown  in  Mexico,  and  on  the 
other  hand,  the  persons  who  are  suffering  from  it  in  its  first  stages  when  it  was 
not  as  easy  to  recognize  the  symptoms  which  render  it  so  visible  in  a  more  ad- 
vanced stage,  several  cases  presented  themselves  in  Salina  Cruz,  Tehuantepec 
and  Sta.  Lucrecia,  which  were  confined  to  the  immigrants  themselves.  As  soon 
as  the  sanitary  authorities  discovered  these  cases,  they  immediately  required 
that  the  patients  should  be  reshipped  to  their  own  country  and  gave  orders  that 
no  person  suffering  from  beri  beri  should  be  allowed  to  land. 


178  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Trachoma  was  a  disease  that  in  Mexico  was  only  known  to  oculists,  and  it 
must  have  been  so  rare  that  a  knowledge  of  it  had  not  reached  the  generality 
of  the  medical  public,  and  still  less,  the  laity.  A  distinguished  opthalmologist  of 
Mexico,  Dr.  Lorenzo  Chavez,  had  occasion  to  observe  last  year  a  small  epidemic 
of  trachoma  in  one  of  the  Government  schools,  and  called  attention  to  the  dan- 
ger of  its  propagation.  This  fact  led  the  Sanitary  Authorities  to  fix  their  at- 
tention on  the  possibility  of  trachoma  being  introduced  by  the  Asiatic  immigrants, 
and  on  the  danger  of  that  disease  spreading  through  the  country.  The  Sanitary 
Delegates  in  the  ports  having  been  warned,  they  commenced  to  note  the  num- 
ber of  persons  suffering  from  trachoma  who  reached  the  Republic,  and  naturally 
it  was  found  that  those  arriving  in  the  Pacific  ports  were  more  numerous  than 
those  who  arrived  by  the  Gulf  ports.  In  one  steamer,  the  number  of  persons 
suffering  from  trachoma  was  found  to  be  220. 

The  Supreme  Board  of  Health  then  asked  the  Department  of  the  Interior 
to  prohibit  the  landing  of  such  immigrants  and  they  were  therefore  returned  to 
China,  and  a  ministerial  declaration  was  obtained  to  the  effect  that  immigrants 
suffering  from  this  disease  would  not  be  allowed  to  land  in  any  of  the  Gulf 
or  Pacific  ports  of  this  Republic. 

In  order  to  prevent  the  introduction  of  any  of  the  above  diseases,  a  careful 
inspection  is  made  of  the  immigrants  before  they  embark  in  the  port  of  Hong 
Kong,  which  is  that  from  which  the  Chinese  immigration  generally  proceeds. 

For  this  purpose  a  physician  has  been  sent  to  that  port  with  the  character 
of  delegate  of  the  Supreme  Board  of  Health,  and  commissioned  to  prevent  the 
embarkation  of  all  emigrants  who  may  be  suffering  from  bubonic  plague,  cholera 
and  other  acute  transmissible  diseases. 

We  are  now  studying  a  law  which  will  prevent  the  landing  in  our  ports  of 
persons  suffering  from  tuberculosis,  scrofula,  malaria  (acute  for  the  moment), 
beri  beri,  trachoma,  and  other  transmissible  chronic  diseases.  It  is  likewise  pro- 
posed to  prohibit  the  landing  of  the  insane,  aged,  idiotic  children,  those  whose 
constitution  is  much  debilitated  by  any  previous  disease  or  by  organic  weakness ; 
the  lame,  one  armed,  humpbacks  or  deformed  who  may  be  unable  to  work;  and 
of  all  those  who  may  become  a  public  charge. 

We  have  hopes  that  if  the  Legislature  will  enact  a  law,  which  we  now  have 
under  study,  we  will  not  only  keep  ourselves  free  from  the  diseases  which  hitherto 
have  been  unknown  to  us,  but  also  protect  our  neighbors  from  those  diseases 
by  not  admitting  them  into  our  territory. 

I  invite  the  Honorable  Delegates  to  this  Congress  to  suggest  similar  measures 
to  those  we  have  already  adopted,  to  their  respective  Governments,  or  such 
as  will  soon  form  part  of  our  Sanitary  Legislation. 

If  all  the  nations  of  America  would  form  a  close  alliance  in  order  to  prevent 
extent  of  our  continent,  we  would  contribute  in  a  very  efficacious  manner  to 
the  introduction  of  the  sick  or  incapacitated  for  work  throughout  the  vast 
the  improvement  of  the  hygienic  and  social  conditions  of  our  respective  nations. 

THE  BUBONIC  PLAGUE. 

In  order  to  comply  with  the  Programme  of  this  Convention,  I  desire  to  say  a 
few  words  with  respect  to  the  bubonic  plague,  not  because  we  have  this  disease 
amongst  us  at  present,  but  because  we  had  it  in  December  1902  to  May  1903,  and 
because  we  are  threatened  by  the  present  epidemic  which  prevails  in  San  Fran- 
cisco, California.  As  we  were  able  to  completely  and  finally  stamp  out  that 
epidemic,  the  experience  which  we  acquired  has  taught  us  the  measures  which 
are  capable  of  giving  that  result,  and  which  we  now  desire  to  lay  before  this 
Honorable  Convention. 

I  hope  that  a  relation  of  these  measures  will  eventually  serve  to  govern  sani- 
tary authorities  in  any  similar  case,  seeing  that  they  were  sanctioned  by  actual 
experience. 

As  the  most  certain  means  of  preventing  the  propagation  of  an  epidemic  is  to 
diminish  the  number  of  persons  who  might  be  exposed  to  contract  the  disease,  it 
becomes  necessary  to  oblige  the  greatest  possible  number  of  inhabitants  to  leave 
the  invaded  town. 

This  exodus  can  only  be  ordered  in  small  towns;  but  in  larger  cities  fear 
drives  out  all  pusillanimous  people  who  have  sufficient  resources  to  leave. 

This  measure  is  of  great  efficacy  but  always  on  the  condition  that  the  persons 
leaving  do  not  carry  with  them  the  germ  of  the  disease. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

In  order  to  avoid  this  danger  a  medical  commission  is  appointed  to  examine 
the  persons  who  propose  to  leave  the  town,  and  to  prevent  the  departure  of  those 
who  are  actually  sick  or  suspected  of  being  so.  Certificates  are  issued  to  healthy 
persons  which  serve  them  as  passports,  and  a  register  is  kept  in  which  are  en- 
tered their  names,  sex,  age,  civil  status  and  destination,  all  of  which  data  are 
forwarded  in  a  note  to  the  authorities  of  the  place  to  which  the  emigrant  goes,  in 
order  that  he  may  be  kept  under  observation  for  ten  days  from  that  on  which  he 
started  from  the  infested  town. 

It  is  therefore  necessary  to  procure  the  departure  from  the  infested  town  of  the 
greatest  possible  number  of  healthy  people.  Another  measure  of  inquestionable 
efficacy  is  found  in  vaccination.  This  was  very  successful  in  Mazatlan,  but  still 
more  so  in  a  small  village  called  Villa  Union,  situated  34  kilometres  from  that 
port.  The  families  who  abandoned  Mazatlan  before  the  inspection  service  was  es- 
tablished must  have  carried  the  plague  with  them  to  Villa  Union,  with  the  result 
that  thirty-four  people  were  taken  sick  of  whom  nine  died.  But  from  the  moment 
that  the  first  cases  appeared  a  similar  service  was  organized  to  that  of  Mazatlan, 
which  is  referred  to  further  on,  and  especially,  steps  were  taken  to  commence  the 
application  of  the  Besredka  vaccine,  which  was  administered  to  3,575  persons  who 
were  liable  to  take  the  disease,  and  the  epidemic  was  entirely  extinguished. 

It  is  therefore  necessary  to  vaccinate  the  whole  or  at  least  the  greater  part  of 
the  residents  of  the  infested  town. 

The  isolation  of  the  sick  is  a  method  that  has  been  most  frequently  adopted; 
but  this  encounters  the  same  difficulty  everywhere,  which  consists  of  the  finding 
of  the  persons  attacked,  who  are  hidden  by  their  relatives  for  fear  that  they  will 
be  carried  to  the  lazarette. 

Experience  shows  that  the  obligatory  declaration  by  the  physicians  is  not  suf- 
ficiently timely,  because  they  are  over-persuaded  by  the  families  or  require  to 
wait  until  they  can  make  a  diagnosis,  and  for  one  or  another  reason  they  do  not 
give  timely  notice  and  neither  do  the  managers  of  factories  or  workshops  comply 
with  that  provision,  for  fear  of  losing  their  hands. 

In  one  word,  in  spite  of  the  penalties  imposed  by  the  Sanitary  Code,  the  obliga- 
tory declaration  is  neither  complete  nor  timely,  and  in  practice  it  has  been  found 
necessary  to  adopt  other  means,  which  are  found  in  the  domiciliary  visit.  In 
Mazatlan  this  was  carried  on  by  the  organization  of  Sanitary  Brigades  which 
were  composed  of  very  able  agents  who  made  house  to  house  visits  so  as  to  take 
the  dwellers  by  surprise,  and  if  they  found  any  person  in  bed  or  who  appeared 
sick,  they  took  his  temperature,  examined  his  neck,  his  armpits  and  groins,  and 
so  discovered  those  who  had  taken  the  disease. 

It  is  therefore  necessary,  for  the  purpose  of  discovering  the  sick  or  suspected 
persons,  to  make  a  house  to  house  visit. 

Once  a  suspicious  case  was  discovered,  it  was  isolated  in  a  special  hospital,  to 
be  submitted  to  a  careful  and  constant  observation,  and  as  soon  as  the  disease  was 
confirmed,  the  patient  was  removed  to  the  lazarette. 

It  is  therefore  necessary  to  have  a  hospital  for  suspected  cases. 

In  order  to  perfect  the  isolation  of  confirmed  cases,  a  lazarette  was  utilized  on 
the  Belvedere  Island  in  the  port  of  Mazatlan.  In  this  lazarette  a  ward  was  dedi- 
cated to  the  sick  and  another  to  the  convalescents,  this  proceeding  being  founded 
on  the  experience  of  Kitasato,  that  the  patients  continue  to  be  dangerous  during 
the  four  weeks  following  their  entry  into  the  convalescent  stage. 

It  is  therefore  necessary  to  establish  a  lazarette  for  the  coniirmed  cases,  as  well 
as  for  the  convalescents. 

As  those  persons  who  surround  the  isolated  patient  might  have  the  disease  in 
a  state  of  incubation,  it  became  necessary  to  watch  them,  and  for  that  purpose 
an  observation  camp  was  established  on  the  slopes  of  the  Velodromo  hill.  As 
soon  as  a  sick  man  was  removed  from  his  house,  all  the  other  persons  dwelling 
in  it  were  taken  to  the  temporary  sheds  that  had  been  erected  under  the  best  pos- 
sible conditions,  and  where  they  wefe  fed  and  their  clothing  was  changed  for 
new  and  clean.  The  clothing  with  which  they  reached  this  camp  was  promptly 
burnt. 

From  the  above  remarks  it  will  be  seen  that  in  order  to  render  the  isolation 
efficient,  it  is  indispensably  necessary  to  establish  the  following  institutions: 

A  hospital  for  suspected  cases;  a  lasarette  for  the  confirmed  cases;  a  depart- 
ment in  the  latter  for  the  convalescents,  and  an  observation  camp  for  those  who 
have  surrounded  the  sick  person. 


l8o  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Once  the  house  in  which  the  patient  was  discovered  was  disoccupied,  it  was 
disinfected  and  measures  were  taken  for  the  destruction  of  the  rats  and  mice. 

The  disinfection  was  carried  out  by  means  of  a  solution  of  bichloride  of  mer- 
cury at  2  per  1000,  which  was  sprayed  by  means  of  the  Japy  apparatus,  or  of 
pumps.  The  floors,  walls  and  roofs  were  washed ;  the  clothing  of  any  value  was 
removed  to  the  disinfection  stoves,  which  were  supplied  by  the  French  firms  of 
Geneste  Herscher  and  Dehaitre.  The  clothing  of  little  value  was  incinerated. 

As  Mazatlan  contained  many  huts  which  could  not  be  disinfected  by  reason  of 
the  materials  of  which  they  were  built,  or  of  the  many  cracks  and  openings  in  the 
walls,  they  were  burnt.  In  this  manner  there  were  1060  houses  destroyed  in 
Mazatlan,  64  in  the  village  of  Villa  Union  and  57  in  that  of  Siqueros.  This 
method  had  the  advantage  of  destroying  at  the  same  time  the  rats  and  mice. 

According  to  the  above  it  is  necessary  to  destroy  by  fire  those  houses  which 
cannot  be  properly  disinfected, 

The  rats  and  mice  were  purchased  at  fifteen  cents  per  animal  and  the  author- 
ities were  thus  enabled  to  kill  6,982. 

The  Danzy  virus  was  taken  advantage  of  to  produce  in  those  rodents  an 
epizootic  which  does  not  attack  man.  We  have  no  means  of  estimating  the 
number  of  animals  which  were  killed  by  this  method. 

In  order  to  destroy  the  fleas,  the  floors  of  the  dwellings  were  sprayed  with 
a  solution  of  bichloride  of  mercury. 

It  is  therefore  urgently  necessary  to  destroy  the  rats,  the  mice  and  the  fleas. 

For  the  purpose  of  preventing  the  propagation  of  any  epidemic,  the  following 
measures  were  taken: 

The  whole  of  the  inhabitants  of  Mazatlan  were  reminded  of  their  obligation 
to  report  the  existence  of  any  sick  person  in  the  houses,  schools,  colleges, 
factories,  workshops,  barracks,  etc. 

The  schools  were  ordered  to  be  closed  and  no  large  number  of  persons  were 
allowed  in  the  churches,  whilst  the  great  religious  ceremonies  of  Holy  Week 
were  ordered  suspended. 

Orders  were  given  for  the  vaccination  of  the  people,  at  first  with  the  Yersin 
serum,  and  afterwards  with  the  Haffkine  and  Besredka  serums. 

Orders'  were  given  for  the  more  frequent  watering  and  sweeping  of  the 
streets,  and  for  the  daily  destruction  of  the  garbage  and  sweepings  by  fire. 

A  laboratory  was  organized  for  the  purpose  of  examining  the  rats  and  mice. 

Steps  were  taken  for  disinfecting  the  markets,  cowsheds  and  barracks. 
Wherever  the  hollows  in  the  streets  permitted  standing  water,  they  were  levelled 
up,  and  a  ditch  which  ran  across  the  town  and  contained  foul  water,  was  closed. 

The  measures  adopted  to  prevent  the  disease  from  spreading  beyond  Mazatlan 
by  land  were  the  following: 

All  persons  emigrating  were  examined  as  above  stated;  the  clothing  which 
they  carried  along  with  them  was  disinfected;  their  baggage  was  inspected, 
and  a  memorandum  of  the  persons  leaving  was  forwarded  to  the  authorities 
in  their  place  of  destination. 

On  the  most  frequented  high  roads  leading  out  of  Mazatlan,  and  at  a  certain 
distance  from  that  city,  a  first  line  of  sanitary  stations  was  established  which 
were  intended  to  make  an  inspection  of  all  persons  emigrating. 

At  a  greater  distance  there  was  a  second  line  of  sanitary  stations,  and  lastly 
in  all  those  States  of  the  Republic  which  adjoined  that  of  Sinaloa — in  which 
Mazatlan  is  situated — the  respective  Governments  also  established  their  own 
sanitary  stations. 

Each  one  of  these  consisted  of  a  department  in  which  persons  suspected 
of  bubonic  plague  could  be  lodged ;  of  another  dedicated  to  the  confirmed  cases 
and  of  still  another  for  the  convalescents.  There  was  also  a  disinfecting  stove 
of  one  of  the  models  above  mentioned,  a  room  dedicated  to  the  disinfection 
of  merchandise  by  means  of  sulphurous  acid,  a  bathing  department,  and  living 
rooms  for  the  staff,  all  making  a  complete  sanitary  station. 

I  must  inform  you  that  there  were  only  wagon  roads  leading  out  of  Mazatlan, 
and  therefore  the  sanitary  stations  were  arranged  in  such  a  manner  that  the 
passengers  who  left  on  horseback  or  by  coach,  would  reach  the  first  station  at 
the  end  of  the  first  day's  journey,  so  that  if  any  passenger  was  sick  or  suspected 
of  sickness,  he  could  be  detained  there. 

The  second  day's  journey  brought  the  travellers  to  the  second  sanitary  station, 
and  if  anyone  fell  sick  on  the  third  day  of  the  journey,  he  would  find  the  sanitary 
stations  which  had  been  established  by  the  States  adjoining  that  of  Sinaloa. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  l8l 

In  order  to  prevent  the  travellers  who  fled  from  Mazatlan  avoiding  the 
neighborhood  of  the  sanitary  stations  by  not  following  the  regular  roads,  but 
rather  the  by-paths,  a  flying  brigade  was  organized  under  the  orders  of  a 
physician,  ancl  which  kept  a  watch  over  those  little  traveled  ways  in  order  to 
collect  any  sick  persons  who  were  found  and  take  them  to  the  regular  stations. 

From  the  above  it  will  be  seen  that  it  is  desirable  to  establish  sanitary  sta- 
tions around  the  infested  city. 

In  order  to  prevent  the  transmission  of  a  disease  by  sea,  the  following  measures 
were  adopted: 

The  sanitary  code  of  the  Republic,  the  maritime  sanitary  regulations  and  the 
additions  to  Chapter  II  of  those  regulations,  which  have  special  reference  to  the 
bubonic  plague,  are  the  laws  of  International  Sanitary  Police  which  are  intended 
to  protect  our  country  against  the  transmissible  diseases  which  might  come  from 
abroad,  and  the  public  was  warned  of  the  necessity  of  observing  them. 

The  ports  designated  as  those  which  would  be  allowed  to  admit  vessels  from 
Mazatlan  were  Guaymas,  Manzanillo,  San  Bias  and  Acapulco.  In  the  last  named 
port  we  had  a  lazarette  already  established. 

All  the  inhabitants  of  Mazatlan  who  desired  to  leave  by  sea  were  allowed 
to  do  so,  on  condition  that  they  were  in  the  enjoyment  of  good  health.  For 
this  purpose  a  commission  was  organized  to  examine  the  passengers,  disinfect 
their  baggage  and  the  merchandise  which  might  be  shipped.  This  commis- 
sion kept  a  record  of  the  name,  surname,  sex,  age,  nationality,  civil  status,  etc., 
of  every  person  who  desired  to  depart,  and  issued  him  a  certificate  stating  that 
he  was  in  good  health  at  the  time  he  left  the  port,  and  also  that  his  baggage 
and  goods  had  been  disinfected.  The  delegate  in  the  port  had  charge  of  the 
disinfection  of  the  ship  and  cargo,  the  destruction  of  the  rats  and  mice,  and 
also  issued  his  certificate  that  the  ship  was  immune  from  the  plague. 

In  order  to  supply  the  provisions  required  in  Mazatlan,  the  vessels  which 
brought  them  were  made  to  anchor  outside  of  the  port  and  the  Delegate  of  the 
Board  would  proceed  to  the  ship's  side  in  a  boat  for  the  purpose  of  receiving 
the  provisions,  but  preventing  all  communication  between  the  persons  from 
shore  and  the  ship's  crew,  after  which  the  Delegate  would  issue  a  certificate 
of  the  manner  in  which  the  operations  had  been  carried  on. 

Due  to  all  of  these  precautions,  the  epidemic  was  stamped  out  within  a  period 
of  six  months.  The  diagram  now  presented  to  the  Delegates  can  give  a  better 
idea  of  the  work  which  was  carried  out. 

As  there  is  an  epidemic  of  bubonic  plague  now  in  the  City  of  San  Francisco, 
California,  the  Government  of  the  Mexican  Republic  has  issued  a  declaration 
to  the  effect  that  it  considers  that  port  infected.  The  Board  of  Health  has 
reminded  its  Delegates  in  the  ports  and  frontiers  of  the  legal  provisions  above 
referred  to;  it  has  made  important  repairs  in  its  sanitary  stations;  has  completed 
that  of  Mazatlan;  has  sent  a  disinfecting  stove  to  Ensenada,  and  has  supplied 
the  principal  ports  on  the  Pacific  Coast  with  anti-plague  serum. 

MALARIA. 

As  it  is  the  duty  of  the  Mexican  Delegation  to  indicate  the  transmissible  dis- 
eases which  prevail  in  this  Republic,  and  it  has  no  exact  figures  available  which 
would  show  the  frequency  of  malaria,  on  account  of  the  difficulties  which  hinder 
the  collection  of  these  statistics,  the  present  report  is  limited  to  a  map  which 
shows  the  geographical  distribution  and  comparative  frequency  of  the  disease. 
Nor  can  any  consideration  be  given  to  the  mortality  returns  because  this 
disease  does  directly  result  in  death,  except  in  cases  of  pernicious  fever,  and 
malarial  anemia,  which  predispose  the  patient  to  contract  the  other  fatal 
disease,  it  does  not  figure  amongst  the  causes  of  death. 

As  regards  malaria,  we  already  know  the  germ  that  produces  it,  the  agent 
which  transmits  it,  and  the  method  of  curing  it;  but,  nevertheless,  we  find  it 
scattered  through  such  extensive  territories  and  among  so  many  different 


A  patient  suffering  from  malaria;  an  anopheles  mosquito  to  sting  him,  and  a 
predisposed  person  to  receive  the  inoculation  from  that  mosquito. 

Theoretically,  the  problem  is  solved  by  disassociating  the  first  two  factors,  or 
by  conferring  immunity  on  healthy  persons. 


1 82  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

In  fact,  if  we  isolate  the  patient  in  rooms  whose  doors  and  windows  are  cov- 
ered with  wire  netting,  the  mosquito  can  not  get  in  to  sting  him. 

If  we  could  destroy  all  the  mosquitoes  of  the  genus  "anopheles"  there  would 
be  no  agent  to  transmit  the  disease  from  the  sick  to  the  healthy  man. 

And  lastly,  if  we  could  confer  immunity  on  healthy  persons,  the  propagation 
of  malaria  would  be  impossible. 

But  these  resources  which  are  so  simple  in  expression,  find  great  difficulties 
in  their  application,  which  we  will  try  to  set  forth  in  order  to  study  the  means 
of  overcoming  them. 

In  diseases  which  assume  an  acute  form,  the  patient,  finding  himself  obliged 
to  take  to  his  bed,  gives  himself  up,  so  to  speak,  to  the  Sanitary  authorities; 
and  this  is  what  takes  place  in  cases  of  bubonic  plague,  cholera,  yellow  fever, 
scarlet  fever,  measles,  typhus,  etc.  But  those  who  suffer  from  malaria,  unless 
in  the  pernicious  or  ordinary  acute  form,  are  not  confined  to  their  beds;  they 
go  in  and  out  of  their  houses,  attend  to  their  ordinary  occupations,  do  not 
consult  a  physician,  and  therefore  do  not  come  under  the  supervision  of  the 
sanitary  authorities  until  the  disease  assumes  an  acute  form ;  but  as  these  patients 
who  suffer  from  the  chronic  form  are  liable  to  be  stung  by  mosquitoes  which 
are  thereby  infected,  they  are  as  much  a  source  of  danger  as  those  who  suffer 
from  the  acute  form,  whilst,  on  the  other  hand,  as  they  are  so  numerous  in 
marshy  countries,  it  is  almost  impossible  to  subject  them  to  isolation,  which,  if 
possible,  would  be  a  measure  of  unquestionable  efficiency,  as  it  is  with  regard 
to  yellow  fever. 

The  second  measure  would  be  the  extinction  of  mosquitoes  of  the  genus 
''anopheles."  This  work  has  been  undertaken  with  great  success  in  some  parts, 
as,  for  instance,  in  Ismailia,  where  it  was  tried  for  the  first  time,  and  by 
ourselves  on  the  "Eldorado,"  State  of  Sinaloa,  as  well  as  in  other  places  where 
we  had  special  services  for  the  suppression  of  yellow  fever.  This  method  con- 
sists in  the  etxermination  of  the  larvae  of  the  mosquitoes,  whenever  they  are 
discovered  in  water  tanks  or  pools  where  the  female  deposits  its  eggs. 

But  if  it  is  a  question  of  such  large  areas  as  those  in  our  territory  which 
are  occupied  by  immense  swamps  in  which  the  mosquitoes  breed  in  fabulous 
numbers,  the  resources  which  are  available  and  practicable  in  the  cities  become 
impracticable  in  such  an  enormous  scale. 

There  are  still  other  resources,  of  which  the  principal  consists  in  the  drainage 
of  marshy  lands  or  the  spreading  of  oil  over  the  waters.  The  first  of  these 
methods  has  been  carried  out  in  England  with  success  for  many  years  back. 
The  marshes  are  made  to  disappear  either  by  drainage  or  by  filling  up.  But 
this  method,  although  really  efficient,  is  slow  and  very  expensive  when  the 
marshes  cover  a  large  area. 

As  regards  smaller  areas  of  water,  we  have  the  resource,  which  is  always 
very  effective,  of  covering  them  with  a  thin  layer  of  petroleum.  This  method 
is  the  one  which  we  are  now  employing  in  Merida,  Progreso,  Coatzacoalcos, 
Veracruz  and  Tampico,  on  the  Gulf  Coast,  and  Salina  Cruz,  on  the  Pacific.  For 
the  last  four  years  our  Government  has  appropriated  large  sums  of  money  for 
the  campaign  against  yellow  fever  and  malaria,  and  these  sums  are  employed 
all  over  the  zone  of  the  State  of  Veracruz  which  is  included  between  Cordoba 
and  Santa  Lucrecia,  and  on  the  Isthmus  of  Tehuantepec. 

When  we  have  been  able  to  extinguish  yellow  fever,  the  numerous  staff  that 
we  have  now  employed  in  that  campaign  will  go  from  district  to  district, 
executing  the  same  efficient  work  which  has  been  carried  out  in  the  place  above 
named  during  the  last  four  years. 

The  other  resource  which  we  have  at  our  disposal  through  our  knowledge 
of  the  germ  of  the  disease  and  its  methods  of  transmission  is  that  of  procuring 
the  immunity  of  persons  who  may  have  to  expose  themselves  to^the  bite  of 
infected  mosquitoes.  The  means  which  are  at  present  available  consist  in  the 
administration  of  salts  of  quinine,  which  is  both  preventive  and  curative.  The 
experience  acquired  in  Italy,  in  those  parts  of  Africa  where  these  salts  have 
been  employed,  and  in  our  own  country,  have  demonstrated  the  efficiency  of  these 
methods,  and  we  propose  to  employ  on  a  larger  scale  under  the  supervision  of 
the  brigades  which  are  now  almost  exclusively  working  against  yellow  fever. 
But  in  order  to  make  the  struggle  against  malarial  fevers  really  effective  and 
to  convert  it  into  a  universal  resource,  it  is  necessary  for  us  to  preach  by  means 
of  books,  of  the  scientific  and  the  general  press,  and  of  lectures,  the  doctrine 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  183 

of  the  transmission  of  malaria  and  the  powerful  resources  which  are  available 
against  it,  and  not  leave  this  task  to  the  exclusive  attention  of  the  authorities. 

I,  therefore,  propose  to  this  Honorable  Convention,  that  we  commence  a 
crusade  against  malaria,  in  the  same  lines  as  those  which  we  have  already 
undertaken  against  tuberculosis.  If  we  can  convince  every  man  of  the  dangers 
offered  by  swampy  countries,  and  that  it  is  within  his  power  to  take  precautions 
against  the  bite  of  the  mosquito;  if  we  could  inculcate  in  him  wisdom  of 
sleeping  under  a  mosquito  net,  of  having  the  doors  and  windows  of  his  dwelling 
provided  with  screens  that  will  prevent  the  entrance  of  the  mosquito;  if  we  can 
teach  him  to  cover  with  oil  the  pools  of  water  which  can  not  be  drained  or 
filled  up;  if  we  can  accustom  him  to  use  small  quantities  of  quinine  which  will 
afford  him  protection  when  he  can  not  have  that  of  the  gauze  curtains  or 
screened  doors  and  windows,  we  will  convert  each  man  into  a  co-operator 
in  this  great  task. 

I  come  to  propose  the  adoption  of  these  methods  after  having  seen  the 
practical  and  good  results  that  they  have  given  in  our  campaign  against  yellow 
fever,  and  also  in  view  of  the  experience  that  we  have  acquired,  even  though 
in  a  small  scale,  in  the  "Eldorado"  property,  in  the  State  of  Sinaloa. 

TYPHUS    FEVER. 

Typhus  is  a  disease  that  has  for  many  years  prevailed  in  an  endemic  form 
in  that  tableland  which  is  known  by  the  name  of  Anahuac.  At  different  periods 
it  has  assumed  an  epidemic  form  and  sometimes  has  caused  great  mortality. 

As  this  disease  is  already  well  known,  the  Mexican  Delegation  confines 
itself  to  a  mere  exposition  of  diagrams,  so  as  to  fulfill  the  program  which  governs 
the  labors  of  this  Convention. 

The  first  of  these  diagrams,  which  covers  a  period  of  thirty  years,  from 
1869  to  1898,  inclusive,  represents  the  number  of  fatal  cases  from  this  disease 
in  each  month  of  the  different  years,  with  a  comparison  of  this  mortality  with 
that  caused  by  diseases  of  another  character.  As  the  diagram  shows,  during 
this  period  there  was  a  notable  exacerbation  of  the  disease  commencing  from 
1875,  maintained  in  1876,  decreasing  during  the  last  months  of  that  year  and 
again  rising  until  it  reached  its  maximum  in  April,  1877,  and  then  remaining  in 
an  endemic  form  until  1883.  From  this  year  to  1892  there  were  outbreaks 
of  slight  importance;  but  in  1893  we  had  one  of  the  most  severe  epidemics 
on  account  of  its  great  spread  and  the  number  of  deaths  it  caused.  In  1897 
there  was  a  slight  exacerbation  that  with  unimportant  variations  declined 
in  1898. 

Number  2  is  a  comparative  diagram  of  the  general  mortality  from  typhus 
and  that  observed'  in  the  hospitals,  showing  the  deaths  caused  in  each  sex. 
The  diagram  also  compares  these  data  with  those  relating  to  the  rainfall 
during  the  years  1898  to  1906.  During  the  period  under  consideration,  there 
was  an  outbreak  in  an  epidemic  form  during  1901,  which  declined  during  the 
months  from  June  to  November  of  that  year,  increased  up  to  April,  1902, 
diminished  up  to  September  of  that  year,  and  with  slight  exacerbations  during 
the  winter  it  reached  an  endemic  form  during  the  following  years,  but  with  an 
increase  from  November,  1905,  to  February,  1906.  It  commenced  to  decline 
in  April  of  last  year  and  has  now  assumed  an  enedemic  form. 

In  a  general  way  we  may  say  that  the  disease  decreases  during  the  rainy 
season  and  increases  in  the  dry  season.  There  is  an  almost  constant  ratio 
between  the  mortality  observed  in  the  hospitals  and  among  the  general  public, 
as  it  may  be  seen  since  the  year  1898,  when  a  comparison  was  established 
between  the  data  of  the  mortality  registered  in  those  establishments  and  the 
total  number  of  deaths. 

The  third  .diagram,  which  represents  the  present  year,  only  indicates  the  slight 
outbreak  which  took  place  in  the  months  of  January  to  March,  and  the  well- 
marked  decrease  between  the  months  of  April  and  July. 

The  measures  that  have  been  adopted  in  order  to  combat  the  epidemic 
outbreaks,  especially  of  late  years,  have  consisted  in  the  supply  of  good  drinking 
water  to  the  poorest  quarters  of  the  city  which  were  not  supplied;  in  improving 
the  watering  and  sweeping  of  the  streets  and  squares;  in  cleaning  the  apartment 
houses;  in  cleaning  out  the  silt  from  the  house  drains,  and  in  the  removal  of 
all  refuse  from  the  city.  The  isolation  of  the  sick  is  carried  out  in  their  dwell- 
ings whenever  possible,  and  when  it  is  not,  they  are  removed  to  the  special 


184  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

hospital  provided  for  typhus  patients,  or  else  to  the  ward  provided  for  them  in 
the  General  Hospital.  The  houses  are  disinfected  as  soon  as  the  patients  are 
removed  to  the  hospital,  or,  if  they  remain  in  their  own  dwelling,  as  soon  as  the 
disease  reaches  its  termination.  As  the  physicians  who  attend  or  casually  see 
a  person  suffering  from  typhus  are  under  the  obligation  of  notifying  the  fact 
to  the  Sanitary  Authorities,  and  the  persons  in  charge  of  schools,  colleges,  work- 
shops, factories,  barracks,  etc.,  are  also  under  obligation  to  give  notice  of  the 
cases  which  may  occur  in  their  respective  establishments,  we  generally  know 
where  the  disease  makes  its  appearance.  The  sanitary  inspectors  of  the  Board 
of  Health  at  once  make  their  first  visit  and  declare  whether  the  patient  can  be 
attended  at  home  or  must  be  removed  to  the  hospital,  and  they  also  notify 
the  Board,  so  that  it  may  order  that  removal  and  the  respective  disinfection 
at  the  proper  time.  If  the  persons  attending  a  typhus  patient  are  very  poor  the 
soiled  clothing  which  they  wear  is  exchanged  for  new  and  clean. 

During  the  last  epidemic,  the  Supreme  Board  of  Health  established  special 
services  for  the  supply  of  water,  cleaning  of  the  city,  gratuitous  baths,  and  wash 
houses,  in  order  that  the  poor  classes  might  have  the  free  use  of  the  same. 

There  are  well  founded  hopes  that  when  the  water  supply  is  increased,  as  it 
\vill  shortly  take  place,  up  to  600  liters  per  day  per  inhabitant;  when  the  sewer 
system  is  completed  and  the  city  well  paved,  and,  specially  when  the  old  and  poor 
quarters  of  the  city  are  reconstructed  and  wide  streets  opened  up  which  will 
give  access  to  houses  erected  under  hygienic  plans,  and  when  an  improvement 
is  made  in  the  present  evil  conditions  under  which  the  poorest  classes  live ;  when 
all  improvements  are  carried  out,  typhus  fever  will  disappear  from  our  city. 

As  the  report  presented  by  the  Mexican  Delegation  has  to  cover  the  trans- 
missible diseases  which  prevail  in  the  Capital,  we  will  close  by  stating  that,  as 
regards  typhus,  during  the  present  year  it  has  almost  been  reduced  to  the 
proportions  of  the  usual  endemia. 

INTERNATIONAL  SANITARY  POLICE. 

The  facilities  of  communication  between  men,  whether  by  land  or  by  sea, 
have  resulted  in  the  greatest  benefits  to  humanity;  but  as  there  is  no  benefit 
which  is  not  accompanied  by  its  corresponding  evil,  the  same  can  be  said  with 
respect  to  the  facilities  which  are  afforded  by  steamship  and  railroad  transpor- 
tation. 

In  moving  from  one  place  to  another,  men  carry  with  them  the  diseases  from 
which  they  may  be  suffering.  The  International  Sanitary  Police  has  displayed  the 
greatest  care,  sometimes  to  a  very  exaggerated  degree,  in  its  endeavors  to  pre- 
vent transmissible  acute  diseases  from  being  brought  into  the  ports  of  frontier 
cities,  or  in  more  exact  terms,  it  has  endeavored  to  put  every  obstacle  in  the 
way  of  the  transmission  of  those  diseases,  by  detaining  those  persons  who  are 
sick  or  suspected  of  suffering  from  those  diseases,  in  the  ships  by  which  they 
have  been  transported  or  in  special  lazarettes.  But  as  regards  transmissible 
chronic  diseases,  no  notice  has  been  taken  of  them  by  the  legislators  before  the 
present  time,  and  nevertheless  it  is  as  necessary  to  protect  ourselves  from  the 
acute  transmissible  diseases  as  from  those  which  have  a  slow  development  and 
are  therefore  denominated  chronic. 

In  these  days  when  the  Asiatic  immigration  encounters  such  great  difficulties 
in  its  efforts  to  penetrate  the  United  States  of  America,  its  current  has  been 
turned  towards  the  countries  of  Latin  America.  In  Mexico  we  receive  every 
month  one  or  two  steamers  in  the  port  of  Salina  Cruz,  some  with  Chinese  and 
others  with  Japanese  immigrants. 

Our  Sanitary  Code  provides  that  only  those  persons  will  be  allowed  to  enter 
the  Republic  with  the  character  of  immigrants,  when  they  are  in  possession  of 
certificates  which  prove  their  perfectly  healthy  conditions,  issued  by  the  compe- 
tent authority  in  the  place  of  departure  and  viseed  by  the  Mexican  Consul.  Un- 
der Art.  49  of  that  same  Code,  certificates  which  have  been  issued  two  months 
previous  to  the  date  on  which  the  immigrant  reaches  our  shores  will  be  con- 
sidered null  and  void. 

This  measure  was  found  insufficient  in  practice  because  the  immigrants  might 
have  started  from  their  own  countries  with  the  diseases  in  a  state  of  incubation 
and  reach  our  ports  with  them  already  developed.  It  is  to  be  noted  that  our  sit- 
uation lends  itself  greatly  to  the  transmission  of  disease,  because  the  ships  do 
not  touch  at  any  port  on  their  voyage  but  come  directly  from  the  Asiatic  ports 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  185 

to  ours  on  the  Pacific.  In  view  of  this,  orders  have  been  given  with  respect  to 
Chinese  immigrants,  which  may  be'  briefly  summed  up  as  follows : — 

The  immigrants  must  come  provided  with  certificates  of  health  issued  by  a 
physician  in  the,  port  of  departure,  and  viseed  by  the  Mexican  consul  in  that 
port,  or  in  his  defect,  by  the  United  States  consul. 

Asiatic  immigrants  can  only  be  allowed  to  land  in  the  port  of  Salina  Cruz, 
if  they  are  more  than  ten  in  number;  but  when  their  number  does  not  exceed 
ten,  they  are  allowed  to  land  in  the  ports  of  Acapulco,  Mazatlan,  Guaymas, 
Tampico,  Veracruz  or  Coatzacoalcos. 

Every  ship  which  transports  immigrants  is  received  in  accordance  with  the 
provisions  of  the  Sanitary  Code,  the  Maritime  Sanitary  Regulations,  and  the 
Special  Ruling  which  may  be  issued  by  the  Supreme  Board  of  Health  in  each 
case  and  in  view  of  the  circumstances. 

If  there  are  none  of  these  special  circumstances  present,  the  healthy  immi- 
grants are  at  once  allowed  to  land  and  are  directly  taken  over  a  special  wharf, 
to  the  lazarette  which  is  dedicated  to  them. 

In  this  lazarette  they  are  made  to  bathe,  their  clothing  and  baggage  are  disin- 
iected,  and  they  are  kept  under  observation  for  a  period  of  ten  days. 

If  at  the  end  of  that  period  no  disease  has  made  its  appearance  amongst 
them,  they  are  permitted  to  leave  but  also  required  to  report  to  the  Delegate  of 
the  Supreme  Board  of  Health,  the  point  to  which  each  immigrant  proposes  to 
travel. 

Up  to  the  present,  these  measures  have  been  sufficient  to  keep  us  free  from 
cholera,  bubonic  plague  and  yellow  fever;  but  they  have  not  prevented  the  in- 
troduction into  the  country,  which  has  actually  taken  place,  of  persons  suffering 
from  beri  beri.  As  this  disease  was  entirely  unknown  in  Mexico,  and  on  the  other 
hand,  the  persons  who  were  suffering  from  it  in  its  first  stages  when  it  was  not 
as  easy  to  recognize  the  symptoms  which  render  it  so  visible  in  a  more  advanced 
stage,  several  cases  presented  themselves  in  Salina  Cruz,  Tehuantepec  and  Sta. 
Lucrecia,  which  were  confined  to  the  immigrants  themselves.  As  soon  as  the 
Sanitary  Authorities  discovered  these  cases,  they  immediately  required  that  the 
patients  should  be  reshipped  to  their  own  country  and  gave  orders  that  no  per- 
son suffering  from  beri-beri  should  be  allowed  to  land. 

Trachoma  was  a  disease  that  in  Mexico  was  only  known  to  oculists,  and  it 
must  have  been  so  rare  that  a  knowledge  of  it  had  not  reached  the  generality  of 
the  medical  public,  and,  still  less,  the  laity.  A  distinguished  ophthalmologist  of 
Mexico,  Dr.  Lorenzo  Chavez,  had  occasion  to  observe  last  year  a  small  epidemic 
of  trachoma  in  one  of  the  Government  schools,  and  called  attention  to  the  dan- 
ger of  its  propagation.  This  fact  led  the  Sanitary  Authorities  to  fix  their  at- 
tention on  the  possibility  of  trachoma  being  introduced  by  the  Asiatic  immi- 
grants, and  on  the  danger  of  that  disease  spreading  through  the  country.  The 
Sanitary  delegates  in  the  ports  having  been  warned,  they  commenced  to  note 
the  number  of  persons  suffering  from  trachoma  who  reached  the  Republic,  and 
naturally  it  was  found  that  those  arriving  in  the  Pacific  ports  were  more  numer- 
ous than  those  who  arrived  by  the  Gulf  ports.  In  one  steamer  the  number  of 
persons  suffering  from  trachoma  was  found  to  be  220. 

The  Supreme  Board  of  Health  then  asked  the  Department  of  the  Interior  to 
prohibit  the  landing  of  such  immigrants  and  they  were  therefore  returned  to 
China,  and  a  ministerial  declaration  was  obtained  to  the  effect  that  immigrants 
suffering  from  this  disease  would  not  be  allowed  to  land  in  any  of  the  Gulf  or 
Pacific  ports  of  this  Republic. 

In  order  to  prevent  the  introduction  of  any  of  the  above  diseases,  a  careful 
inspection  is  made  of  the  immigrants  before  they  embark  in  the  port  of  Hong 
Kong,  which  is  that  from  which  the  Chinese  immigration  generally  proceeds. 

For  this  purpose  a  physician  has  been  sent  to  that  port  with  the  character  of 
Delegate  of  the  Supreme  Board  of  Health,  and  commissioned  to  prevent  the 
embarkation  of  all  emigrants  who  may  be  suffering  from  bubonic  plague,  cholera 
and  other  acute  transmissible  disease. 

We  are  now  studying  a  law  which  will  prevent  the  landing  in  our  ports  of 
persons  suffering  from  tuberculosis,  scrofula,  malaria  (acute  for  the  moment) 
beri-beri,  trachoma  and  other  transmissible  chronic  diseases.  It  is  likewise  pro- 
posed to  prohibit  the  landing  of  the  insane,  aged,  idiotic  children,  those  whose 
constitution  is  much  debilitated  by  any  previous  disease  or  by  organic  weakness ; 
the  lame,  one  armed,  humpbacks  or  deformed  who  may  be  unable  to  work;  and 
of  all  those  who  may  become  a  public  charge. 


l86  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

We  have  hopes  that  if  the  Legislature  will  enact  a  law,  which  we  now  have 
under  study,  we  will  not  only  keep  ourselves  free  from  the  diseases  which  hither- 
to have  been  unknown  to  us,  but  alsg  protect  our  neighbors  from  those  diseases 
by  not  admitting  them  into  our  territory. 

I  invite  the  Honorable  Delegates  to  this  Congress  to  suggest  similar  meas- 
ures to  those  we  have  already  adopted,  to  their  respective  Governments,  or  such 
as  will  soon  form  part  of  our  Sanitary  Legislation. 

If  all  the  nations  of  America  would  form  a  close  alliance  in  order  to  prevent 
the  introduction  of  the  sick  or  incapacitated  for  work  throughout  the  vast 
extent  of  our  continent,  we  would  contribute  in  a  very  efficacious  manner  to  the 
improvement  of  the  hygienic  and  social  conditions  of  our  respective  nations. 

ASSISTANCE  AFFORDED  BY  THE  GENERAL  GOVERNMENT  TO 
PORTS  AND  CITIES  IN  THE  REPUBLIC  TO  CARRY  OUT  THE 
SANITATION  AND  WATER  SUPPLY  WORKS. 

The  Mexican  delegation  has  stated  in  its  report  on  the  subject,  what  is  the 
condition  of  the  water  supply  works,  sewerage,  street  pavement  and  all  others 
which  are  executed  or  in  the  course  of  execution  in  the  principal  ports  and 
cities  of  the  Republic.  For  this  reason,  the  present  report  will  be  confined  to 
giving  this  Conference  information  as  to  the  assistance  rendered  by  the  Federal 
Government  in  carrying  out  such  works  in  the  ports  further  on  mentioned,  as 
well  as  in  the  Capital  of  the  Republic. 

The  Municipality  of  Tampico  was  granted  a  subsidy  of  $2,187,529.73  for  the 
sanitation  and  water  supply  works  of  the  city  under  the  contract  of  the  i$th 
of  August,  1902.  Under  another  contract  executed  on  the  3d  of  September, 
1906,  for  the  continuation  of  the  works  in  the  second,  third  and  fourth  zones 
of  the  City  of  Tampico,  the  Federal  Government  granted  a  sum  of  $812,250.00, 
making  a  total  investment  in  those  works  of  $2,099,779.73. 

For  the  purpose  of  assisting  the  municipality  of  Vera  Cruz  in  the  construc- 
tion of  sanitation  and  water  supply  works  under  the  contract  of  the  28th  of 
July,  1901,  a  subsidy  was  granted  of  $3,964^93.94.  The  Federal  Government 
was  charged  with  the  arrangement,  through  the  Department  of  Communications 
and  Public  Works,  of  the  technical  conditions  of  the  contract  executed  with  the 
company  which  undertook  the  work,  as  well  as  with  the  supervision  and  approval 
of  the  work,  material  and  machinery  employed  therein,  until  its  final  completion. 

A  subsidy  of  $676,114.50  was  granted  to  the  Government  of  the  State  of  Vera 
Cruz  to  assist  in  carrying  out  the  sanitation  and  water  supply  works  in  Puerto 
Mexico  (Coatzacoalcos),  under  the  contract  of  the  2d  of  October,  1906. 

In  order  to  carry  out  the  sanitation  work  in  the  City  of  Mazatlan  the  Federal 
Government  granted  the  City  Council  a  sum  of  $600,000  under  the  contract  of 
the  I3th  of  October,  1906. 

The  Federal  Government  executed  four  contracts  on  the  23d  of  May,  1899, 
1 7th  of  March,  1905,  I5th  of  May  and  ist  of  November,  1906,  for  the  execution 
of  the  harbor  and  sanitation  works  in  Manzanillo,  which  were  estimated  under 
those  four  contracts  at  the  sum  of  $7,882,760.00,  and  of  this  amount  $7,348,241.99 
have  been  expended  up  to  the  month  of  September  last. 

The  sanitation  and  water  works  of  the  port  of  Salina  Cruz  are  estimated  to 
cost  $1,104,313.30.  Out  of  this  sum,  $885,240.68  had  been  expended  up  to  the  3Oth 
of  June  last,  leaving  a  balance  of  $119,072.62  available.  An  estimate  has  been 
prepared  for  special  works  to  be  undertaken  in  that  port  to  supply  water  to  the 
port  works,  amounting  to  $86,000,  of  which  $37,677-57  had  been  expended  up  to 
the  same  date,  leaving  a  balance  of  $48,322.43.  The  total  appropriations  for 
the  works  in  that  port  amount  to  $1,190,313.30,  of  which  $922,918.25  have  been 
expended,  leaving  an  available  balance  of  $267»395-(>5' 

And,  lastly,  in  the  capital  of  the  Republic  the  following  sums  have  been  ex- 
pended: In  the  Valley  Drainage  Works,  $15,967,778.17;  in  the  Sanitation  Works 
of  the  city,  $8,210,138.25,  and  in  the  Water  Supply  Works,  $4,339,9% -75,  making 
a  total  expenditure  on  sanitary  works  in  the  capital  of  the  Republic  of  $28,- 
517,900.17.  Besides  this,  other  important  sums  figure  in  the  estimates  of  the 
Department  of  the  Interior  which  are  required  for  the  Water  Supply,  Sanita- 
tion, Drainage,  Sewerage,  Canals  and  General  Cleaning  of  the  city. 

We  therefore  find  that  the  Federal  Government  has  appropriated  the  following 
amounts  to  the  works  above  mentioned : 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  187 

Port  of  Tampico $2,999,779.73 

Port  of  Vera  Cruz 3,964,493-94 

Puerto    Mexico    (Coatzacoalcos) 1,276,114.50 

Port  of  Manzanillo   7,882,760.00 

Port   of    Salina    Cruz 1,190,313.30 

Capital  of  Republic 28,517,900.17 

Total  appropriation $45,831,361.64 

Of  this  sum  there  is  still  available 801,913.06 

MEASURES  TO  BE  ADOPTED  FOR  THE  PREVENTION  OF  TUBERCU- 
LOSIS ON  BOARD  OF  SHIPS. 

On  board  of  vessels  and  especially  in  the  passengers'  cabins  where  persons 
suffering  from  tuberculosis  have  expectorated,  it  is  extraordinarily  easy  to  con- 
tract the  disease,  and  in  order  to  prevent  the  propagation  of  this  terrible  scourge, 
it  is  necessary  to  make  strict  application  of  the  hygienic  methods  which  we  al- 
ready know,  and  which  are  the  easier  as  in  this  case  we  can  count  on  the 
powerful  support  of  the  sanitary  delegates  in  the  ports,  who « can  easily  ascertain 
the  hygienic  conditions  of  the  passengers  and  crew,  and  who  in  the  event  of 
finding  any  confirmed  or  suspected  consumptive,  can  supervise  the  disinfection 
of  the  places  and  clothing  he  has  made  use  of,  and  also  require  that  he  use 
the  spittoons  which  must  be  profusely  distributed  throughout  the  cabins,  berths, 
smoking  room  and  even  on  the  decks.  It  would  be  very  desirable  that  passen- 
gers suffering  from  this  disease  should  supply  themselves  with  pocket  spittoons. 

Should  the  delegate  discover  either  on  the  outward  or  inward  visit  the 
presence  of  any  tuberculous  person  among  the  crew,  he  must  prohibit  such  person 
from  continuing  his  voyage  in  the  ship,  and  should  be  desire  to  do  so,  he 
should  only  be  allowed  to  go  as  a  passenger,  in  such  a  manner  that  he  may  be 
confined  to  his  berth.  The  confirmed  or  suspected  cases  of  tuberculosis  amongst 
the  passengers  should  be  placed  in  a  berth  without  any  curtains  or  other  hang- 
ings, especially  if  they  are  difficult  to  remove  for  the  purposes  of  disinfection. 
The  berth  should  have  a  sufficient  number  of  spittoons  and  notices  pointing  out 
the  propriety  of  making  use  of  them  for  expectoration.  The  napkins  and 
vessels  employed  by  the  patient  should  be  placed  in  boiling  water  for  fifteen 
minutes  immediately  after  use ;  in  sweeping  out  and  cleaning  the  berth  care  should 
be  taken  not  to  raise  any  dust,  and  nothing  must  be  shaken;  the  bed  clothing 
must  be  carefully  folded  and  boiled  for  fifteen  minutes  before  passing  to  the 
laundry.  Whenever  a  tuberculous  patient  disoccupies  a  berth  it  must  be^  care- 
fully disinfected  under  the  supervision  of  the  respective  delegate,  and  this  dis- 
infection will  be  carried  out  by  soaking  the  walls  and  furniture  of  the  cabin 
with  a  solution  of  I  per  i,qoo  of  bi-chloride  of  mercury  and  tartaric  acid,  and 
afterwards  rubbing  them  with  tow  which  must  afterwards  be  thrown  into  the 
fire  or  overboard.  Naturally  all  the  metal  fittings  will  be  protected  with  grease 
against  this  solution,  as  they  are  liable  to  be  attacked  by  the  chloride.  After 
the  operation  is  completed,  the  tow  will  be  passed  over  all  the  metal  fittings 
and  then  burnt  as  above  stated. 

In  order  to  avoid  the  spittoons  from  overflowing  through  the  rolling  of  the 
vessel,  it  would  be  desirable  to  give  them  a  cylindrical  form  with  a  conical 
upper  and  lower  part  connected  by  the  respective  apices,  which  could  be  in  the 
form  of  a  screw  so  as  to  facilitate  cleaning,  or  else  common  spittoons  could  be 
employed  and  fixed  to  the  walls  by  means  of  the  "Cardan"  frame.  It  would 
be  desirable  to  have  them  fitted  with  two  small  side  ears  so  that  they  could  be 
easily  placed  in  series  like  a  voltaic  pile,  and  carried  without  any  fear  of  spill- 
ing their  contents  to  the  place  where  they  are  to  be  cleaned.  The  cleaning  of 
the  spittoons  should  preferably  be  made  on  the  outside  rail,  and  if  possible,  by 
means  of  a  jet  of  boiling  water.  The  stewards  who  carry  out  this  operation 
ought  to  disinfect  their  hands  with  the  solution  of  bi-chloride.  In  order  to 
prevent  the  contents  from  drying  the  spittoons  should  always  contain  a  certain 
quantity  of  water. 


l88  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

REPORT  OF  DR.  RODOLFO  B.   GONZALEZ,  DELEGATE 
FROM  SALVADOR. 

As  Commissioner  of  El  Salvador  to  the  Third  International  Sanitary  Conven- 
tion, I  come  to  comply  with  one  of  the  obligations  that  the  by-laws  impose  upon 
tne. 

The  Government  represented  by  me  not  having  concurred  to  previous  Con- 
ventions, I  desire,  before  informing  you  as  to  the  sanitary  conditions  of  the 
Republic,  to  make  a  brief  history  as  to  its  sanitary  organization. 

SANITARY  ORGANIZATION. 

In  the  year  of  1900  the  regulations  of  health  now  in  force  since  then,  were 
duly  approved.  These  regulations  created  the  Supreme  Board  of  Health  which 
has  worked  with  perfect  regularity  since  its  foundation  with  a  technical  and 
distinguished  staff. 

It  is  formed  by  three  members  of  the  medical  fraternity,  a  pharmacist  and  a 
consulting  lawyer,  as  well  as  with  the  necessary  employees  for  the  service 
of  the  various  departments  of  the  Chemical-Bacteriological  Disinfection,  Sta- 
tistic, etc.,  and  with  the  administrative  staff  required  by  the  Treasurer  and 
the  Secretary's  office. 

Politically,  the  Republic  of  El  Salvador  is  divided  in  fourteen  departments, 
and  the  Board  has  in  each  capital  a  commissioned  physician  acting  in  accord- 
ance with  the  by-laws  of  the  code. 

Every  port  of  the  Republic  has  a  commissioned  physician  who  is  in  charge 
of  the  disinfection — every  port  is  equipped  with  the  necessary  disinfecting  appa- 
ratus and  everything  pertaining  to  the  International  Marine  Health. 

Practically,  they  are  branches  of  the  Board,  the  General  Direction  of  Vaccina- 
tion, the  Direction  of  Venereous  Prophylaxis,  the  Slaughter  House  Inspection, 
Food  and  Beverages,  the  Direction  of  Alcohols  and  Liquors  and  the  Board 
of  Fomento  and  Waters. 

The  Board  is,  in  conformity  with  the  by-laws,  an  independent  corporation 
which  has  incomes  by  itself  created  by  the  Law,  but,  in  the  administrative 
organization,  it  is  dependent  of  the  Government. 

It  conducts  an  official  paper  named  "Bulletin  of  the  Superior  Board  of 
Health,"  a  monthly  publication  which  publishes  the  official  decrees  of  the 
Board,  the  reports  of  all  the  commissioners,  the  demographic  statistics  of  the 
Republic,  original  works,  etc.,  etc. 

From  time  to  time  it  publishes  monographs  to  spread  useful  knowledge. 
It  has  been  edited  already,  on  account  of  the  Board,  and  largely  distributed, 
a  number  of  pamphlets  showing  the  prophylactic  measures  which  must  be  ob- 
served to  attack  various  epidemics,  such  as  yellow  fever,  bubonic  pest,  as  well 
as  other  pamphlets  on  the  damages  caused  to  the  human  organism  by  the 
use  of  tobacco  and  alcohols;  on  tuberculosis  and  the  means  of  preventing 
the  contagion;  on  syphilis  and  its  prophylaxis;  on  vaccination  and  small-pox, 
and  several  others  that  I  will  place  before  the  Secretary  when  I  deliver  the 
accompanying  annexes  to  this  report  and  which  I  have  not  received  up  to  this 
writing,  owing  to  a  delay  in  marine  communications.  t 

/ 

GENERAL    DIRECTION    OF    VACCINATION. 

The  vaccination  and  re-vaccination  are  free  to  all  the  inhabitants  of  the 
Republic.  The  respective  regulations  set  forth  that  the  vaccination  be  practiced 
three  months  after  the  birth — and  before  in  case  of  an  epidemic — and  the  re- 
vaccination  every  six  years. 

The  Direction  of  Vaccination  is  in  charge  of  preserving,  distributing  and  pro- 
pagating the  vaccination  all  over  the  country.  In  order  to  properly  fulfill  the 
aforesaid,  it  has  secured  the  necessary  staff  in  the  capital  of  the  Republic  and 
a  vaccination  physician  in  all  the  principal  cities  of  the  country.  There  are, 
furthermore,  traveling  vaccinators — the  number  varying  according  to  the 
necessities,  who  are  in  charge  of  vaccinating  in  small  towns  and  villages. 

Since  its  foundation  the  office  receives  every  fifteen  days,  without  interrup- 
tion, animal  vaccinating  fluid  from  the  Bacterio-Therapeutic  Institute  of  Berne 
(Switzerland),  and  from  the  Pasteur  Institute  of  Paris,  France. 

Up  to  the  last  two  years  the  vaccination  has  been  practiced  exclusively  from 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  189 

arm  to  arm,  utilizing  pustules  from  good  vaccine.  The  animal  lymph  was  kept 
in  prevision  of  an  epidemic  of  small-pox,  but,  as  it  was  noticed  that  the  human 
lymph  was  losing  its  activity  with  the  times,  with  the  continuous  passes  from 
arm  to  arm,  it  was  decided  to  use  from  time  to  time  the  animal  lymph  to 
regenerate  the  human  one,  and  with  this  method  splendid  results  were  obtained. 

The  Board  of  Health  and  the  General  Direction  of  Vaccination,  in  my  charge, 
had  been  working  for  a  long  time  in  order  to  determine  if  it  was  better  to  give 
preference  to  the  animal  or  human  vaccination.  For  this  reason  a  careful  study 
of  comparison  was  established,  founded  on  the  statistics,  using  the  two  vaccines 
on  an  equal  number  of  persons,  brought  as  far  as  possible  to  identical  conditions. 

The  results  obtained  were  not  as  conclusive  as  expected,  as  equally  good  re- 
sults were  obtained  with  both  vaccinations  and  fortunately  no  failure  with  either 
of  them.  The  studies  on  the  matter  were  continued  and  a  matter  of  so  much 
importance  is  still  awaiting  a  conclusion. 

And  as  notwithstanding  these  experiments,  real  European  eminences  continued 
to  allege  that  with  the  human  vaccine  the  syphilis,  tuberculosis,  etc.,  could  be 
transmitted,  not  taking  into  consideration  other  infections,  which  would  be 
common  to  both  vaccinations  and  as  a  rule  dependent  on  the  operator,  it  was 
resolved  that,  as  long  as  this  point  remained  unsolved  in  every  respect,  scien- 
tifically, only  animal  vaccine  should  be  employed  in  El  Salvador. 

Taking  the  opportunity  that,  at  that  time,  Dr.  Gustavo  Baron,  a  physician  of 
vast  illustration  and  a  noted  Bacteriologist,  was  going  to  Europe,  he  was  com- 
missioned to  take  up  this  important  study.  Dr.  Baron,  after  visiting  various 
European  centers,  went  to  Japan,  and  upon  his  return  reported  his  views 
to  this  end. 

It  was  decided  to  establish  in  El  Salvador  the  National  Institute  of  Animal 
Vaccination,  annexed  to  Hospital  Rosales,  a  magnificent  establishment  of  charity, 
recently  constructed  with  all  the  latest  improvements  that  the  modern  science 
advises,  and  one  of  the  test  hospitals  of  the  Continent. 

The  General  Direction  of  Vaccination,  reorganized  in  1900,  has  vaccinated 
since  then,  over  sixty  thousand  people,  as  could  be  seen  by  the  corresponding 
statistics  hereby  attached.  It  can  be  said  that  small-pox  plague  has  practically 
been  exterminated  in  El  Salvador,  if  it  is  taken  into  consideration  that  the  ma- 
jority of  the  inhabitants  are  vaccinated  and  that  they  are  being  vaccinated 
continuously  with  great  activity,  employing  when  required,  the  means  of  ad- 
herence set  forth  by  the  laws.  In  this  respect  it  can  be  said  that  El  Salvador 
has  succeeded. 

Some  years  ago  owing  to  the  war  had  by  Mexico  with  the  Maya  tribes,  a 
small-pox  epidemic  developed  in  the  State  of  Yucatan.  The  epidemic  went  so 
far  as  Belice  (British  Honduras),  thence  to  Honduras,  in  the  adjoining  depart- 
ments with  El  Salvador.  The  epidemic  was  officially  declared  and  although  some 
cases  were  discovered  at  Pasaquina,  Pespire,  Valley  of  San  Lorenzo,  etc.,  all 
of  them  cities  of  El  Salvador,  it  was  not  propagated,  nor  did  it  cause  any  deaths. 
The  measures  of  disinfection  and  isolation  taken  were  sufficient  to  control  such 
a  terrific  epidemic. 

All  details  with  reference  to  this  plague,  can  be  found  in  the  Bulletin  of  the 
Board. 

El  Salvador  has  had  the  satisfaction  that  in  every  instance  that  confluent 
small-pox  has  appeared  in  Central  America  with  more  or  less  epidemic  appear- 
ance (sometimes  by  its  own  account  and  other  by  petition  of  the  Government), 
it  has  been  unable  to  send  vaccinating  fluid  of  acknowledged  activity  in  sufficient 
quantity  to  establish  the  vaccination  in  the  cities  attacked  by  the  epidemic. 

NATIONAL    INSTITUTE    OF    ANIMAL    VACCINATION. 

This  most  important  establishment,  founded  two  years  ago,  is  amply  equipped 
with  every  modern  convenience  to  carry  out  its  duties  in  every  way  satisfactorily. 
It  has  an  adjoining  department  where  calves  destined  to  the  vaccination  are 
rigorously  subjected  to  a  clinic  observation. 

The  vaccination  as  well  as  the  lymph,  its  polarization,  asepsis,  bacteriological 
examination,  putting  up  in  aseptic  tubes,  sealed  by  lamp  process,  etc.,  are  prac- 
ticed in  conformity  with  the  minutest  scientific  modern  prescriptions  by  the 
Director  of  the  Institution,  Dr.  Baron,  whose  name  alone  is  a  guarantee. 

The  Institution  produces  at  present  one  thousand  tubes  of  lymph  every  month 
of  the  best  obtainable  quality,  which  is  sufficient  to  answer  the  actual  require- 


I9O  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

ments,  but  in  case  of  any  epidemic  it  could  produce  over  four  thousand  tubes 
per  month. 

El  Salvador  can  certainly  feel  satisfied  over  the  fact  that  in  case  of  a  plague 
of  small-pox,  it  could  offer  to  any  country  in  the  Continent,  vaccinating  fluid 
from  its  own  Institute  of  the  best  obtainable  quality  and  in  sufficient  quantity 
to  overpower  any  plague. 

All  the  apparatus,  employed  in  the  Institute  of  Salvador,  are  of  French  make, 
of  the  latest  models,  so  far  that  in  the  catalogues  they  are  headed,  "Models  of 
the  Vaccination  Institute  of  El  Salvador." 

During  the  last  year,  the  animal  fluid  for  vaccination  has  been  the  only  one 
used  in  El  Salvador,  produced  in  the  country,  and  excellent  results  have  been 
obtained. 

VENEREOUS    PROPHYLAXIS. 

This  important  branch  of  the  public  health  is  in  charge  of  a  General  Director, 
who  acts  in  accordance  with  the  prescriptions  of  the  code  and  with  the  respective 
regulations.  The  Central  Offices  are  located  in  the  capital,  but  there  is  a 
physician  in  every  important  town  of  the  Republic  and  the  necessary  number  of 
Health  Police.  A  hospital  or  a  clinic  can  be  found  in  every  town  to  attend  to 
the  sick  prostitutes.  In  conformity  with  the  regulations  every  registered  prosti- 
tute must  pass  sanitary  inspection  twice  a  week.  The  Health  Police  looks  after 
the  clandestine  prostitution,  the  most  dangerous  thing  to  the  public  health. 

At  the  present  time  by-laws  for  prostitutes  are  under  study. 

This  important  office,  founded  several  years  ago,  is  in  charge  of  the  analysis 
of  all  the  alcohols  and  liquors  produced  and  sold  in  the  country.  A  decree  ap- 
proved by  the  Superior  Government  determines  the  injurious  substances  that 
can  be  contained  in  alcohols,  liquors  and  fermented  beverages  sold  in  the  country. 

This  office  is  equipped  with  a  complete  chemical  laboratory,  where  all  alcoholic 
and  fermented  drinks  are  carefully  analyzed,  as  they  cannot  be  sold  without  pre- 
viously passing  this  analysis  and  provided  that  the  report  of  same  to  the 
General  Director  is  favorable  as  to  its  chemical  compounds.  Both  the  report 
and  the  analysis  are  published  in  the  Diarlo  Oficial  for  the  public's  knowledge. 

BOARD  OF  PHARMACY   AND    NATURAL   SCIENCES. 

It  is  forbidden,  according  to  the  laws  of  El  Salvador,  the  liberty  of  professions, 
and  therefore  only  those  duly  graduated  are  allowed  to  practice  in  the  country 
as  professionals. 

The  Board  of  Directors  of  the  Medical  and  Pharmaceutical  Faculty  is  in 
charge  of  enforcing  the  above  law  to  see  that  no  others  but  the  academics  from 
the  faculty  or  those  to  it  incorporated  by  previous  examination  or  in  conformity 
with  whatever  international  treaties  may  exist  authorizing  the  validity  of  such 
professional  diplomas  be  permitted  to  practice  in  the  Republic. 

Every  Pharmacy  in  the  country  is  constantly  subject  to  a  close  watch  by  the 
Board  of  Pharmacy  and  Natural  Sciences.  No  other  but  those  duly  graduated 
in  the  Faculty  can  be  in  charge  or  represent  a  pharmacy  or  drug  store,  not  even 
a  physician  having  an  authorization  or  diploma  allowing  him  to  act  as  a 
pharmacist  is  permitted  to  do  so,  according  to  the  laws  he  cannot  act  as  a 
pharmacist  and  physician  at  the  same  time,  and  must  therefore  practice  as  a 
pharmacist  or  as  a  physician. 

It  is  absolutely  prohibited  to  act  as  a  physician  and  pharmacist.  The  head 
of  a  drug  store  is  obliged  to  stay  in  it  as  long  as  the  service  of  same  may  last. 
An  agent  of  the  Board  is  constantly  visiting  the  drug  stores  and  obtaining  the 
signatures  of  their  heads  or  representatives.  The  failure  of  any  of  them  to  be  in 
the  establishment  at  the  time  that  the  agent  makes  his  visit  is  punished  with  a 
fine.  A  second  failure  to  be  in  the  establishment  may  be  punished  with  the 
temporary  or  definite  closing  of  the  establishment. 

The  pharmacy  regulations  stipulate  all  the  medical  substances  which  must  be 
carried  in  stock  in  a  drug  store  and  the  appliances,  instruments  and  all  neces- 
sary apparatus  for  pharmaceutical  manipulations  and  also  the  consulting  books 
that  must  be  handy  to  the  pharmacist. 

Any  violation,  no  matter  how  insignificant  it  may  be,  is  punished  with  a 
fine  or  the  temporary  or  definite  closing  of  the  establishment. 

Nobody  is  allowed  to  sell  drugs  of  any  kind,  no  matter  how  insignificant  they 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  IQI 

may  be,  without  an  authorization  from  the  Board,  which  grants  this  right  as 
a  rule  after  previous  examination  of  the  drug.  Such  rules  have  given  very 
good  results  to  the  public  health. 

The  brief  space  of  this  report  prevents  me  going  into  further  details,  some 
of  them  very  important,  and  which  can  be  found  in  the  attached  regulations. 

The  political  situation  of  El  Salvador,  its  topographical  position  and  the 
density  of  its  population,  are  other  factors  to  show  that  it  ought  to  be  one  of 
the  most  unhealthy  countries.  It  is  fortunately  not  so,  as  with  the  exception 
of  malaria,  which  under  all  its  forms  and  manifestations  is  endemic  in  the  total 
extension  of  the  Republic;  no  epidemic  has  whipped  or  depopulated  the  country 
for  some  time  past,  notwithstanding  the  fact  that  El  Salvador  has  been  always 
interruptedly  in  communication  with  zones  more  or  less  ravaged  by  some  plague. 

El  Salvador  has  been  unable  to  overpower,  notwithstanding  its  constant  effort 
to  do  so,  that  terrific  spectre,  tuberculosis,  that  universal  whip  that  every  day 
causes  larger  destruction  of  humanity. 

The  demographic  curve  shows  a  growing  invasion,  the  mortality  having  reached 
the  cipher — very  alarming — of  6  per  cent  of  the  total  deaths. 

Actually,  the  malaria  and  the  tuberculosis  are,  if  not  the  only,  the  most  terrific 
enemies  against  whom  we  must  struggle  in  El  Salvador.  During  the  years 
of  1906-7  there  was  an  epidemic  of  yellow  fever.  The  epidemic  attacked  with 
preference  all  the  foreigners  not  acclimated,  also  the  military  class.  The  epi- 
demic spread  in  all  directions  localizing  itself  practically  in  zones  (whose  centers 
were  the  cities  of  Alequizaya,  San  Salvador  and  Chinameca)  leaving  inter- 
mediary cities  completely  undamaged.  This  occurrence  attracted  the  general 
attention  and  originated  the  beginning  of  various  studies  on  the  subject.  At 
that  time,  the  mortality  varied  between  thirty  and  forty  per  cent  of  the  people 
attacked,  varying  in  accordance  with  the  region. 

During  those  days  entirely  different  ideas  to  those  prevailing  to-day,  were 
had  with  respect  to  the  etiology  and  pathogeny  of  the  yellow  fever  plague,  but 
in  accordance  with  the  prevailing  ideas  prophylactic  measures  were  dictated, 
and  adequate  civil  and  military  lazarettos  were  established  and  by  these  means 
the  epidemic  was  exterminated. 

At  the  beginning  of  1900  the  epidemic  reappeared  with  the  only  exception  that 
at  this  time  it  attacked  with  little  intensity,  caused  few  deaths  and  was  over- 
powered in  a  short  time. 

Since  that  date  only  one  case  of  small-pox  has  been  accounted  for  and  con- 
firmed as  having  been  imported  from  Panama,  and  only  six  suspicious  cases 
have  been  reported  but  have  caused  no  deaths. 

The  steps  taken  by  the  Board  and  the  regulations  issued  have  been  sufficient 
to  avoid  the  propagation  of  same.  Not  a  single  case  of  bubonic  pest,  cholera 
or  trachome  has  been  accounted  for. 

In  1902  a  suspicious  case  of  beri-beri  in  a  Chinaman  was  discovered  and  cured. 

As  before  stated,  during  such  period  some  cases  of  confluent  small-pox  have 
appeared  duly  confirmed.  The  rapidity  and  energy  employed  in  such  cases  has 
surely  prevented  the  development  of  the  epidemic  or  caused  any  death. 

Last  year,  and  undoubtedly  owing  to  the  fatigue  of  the  service,  an  epidemic 
of  meningitis.,  cerebrum-spinal  infection  in  a  epidemic  manner  like  developed 
in  the  quarters  of  the  First  Regiment  of  Infantry  attacking  over  one  hundred 
men  within  a  period  of  four  months  and  causing  as  per  the  statistics  a  mor- 
tality not  reaching  forty  per  cent  of  the  attacked  ones.  The  epidemic  did  spread 
over  various  cities  concentrating  itself  practically  in  the  Military  Quarters. 

In  view  of  this  the  Military  Clinic  was  equipped  with  a  lazaretto,  a  thorough 
disinfection  was  pursued  in  all  the  quarters,  every  suspicious  person  was  isolated 
and  those  openly  attacked  were  placed  in  other  quarters.  The  military  exer- 
cises were  shortened  to  its  minimum  extent  and  all  known  prophylactic  meas- 
ures were  applied  in  order  to  control  the  plague. 

El  Salvador  has  three  ports  properly  fit  for  the  trade  of  the  country  in  large 
scate  (Acajutla,  La  Libertad  and  La  Union)  and  one  for  coasting  trade  (El 
Triunfo),  all  of  which  are  on  the  Pacific  coast  and  in  fairly  good  sanitary 
conditions,  with  the  exception  of  Acajutla  and  La  Libertad,  as  these  two  ports 
are  located  on  open  roads  and  in  a  sea  of  many  sand  banks  and  naturally  this 
makes  the  navigation  somewhat  difficult,  even  for  small  vessels.  Very  good 
steel  docks  have  been  constructed  in  these  ports  of  considerable  meters  in  length. 

In  order  to  avoid  any  possible  grounding  of  the  vessels  owing  to  the  number 


192  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

of  existing  reefs,  all  vessels  are  anchored  far  away  from  these  docks,  about  one 
mile,  and  of  course  this  causes  delays  and  inconveniences  to  the  trade  in  El  Sal- 
vador, but  on  the  other  hand,  it  favors  the  public  health,  since  at  such  a  dis- 
tance the  mosquitoes,  agents  of  so  many  infections,  can  hardly  reach  there. 

In  every  port  the  malaria  fever  prevails  in  endemic  manner  and  it  causes 
considerable  damages  in  the  inhabitants  of  such  cities.  The  most  unhealthy  is 
Acajutla,  and  this  .is  because  it  is  located  on  the  outlet  of  large  rivers  which, 
during  the  rainy  season,  very  heavy  in  those  regions,  they  overflow,  covering 
great  distances  along  the  coast,  and  this  naturally  favors  wonderfully  the  mul- 
tiplication of  mosquitos. 

La  Libertad  is  in  much  better  condition,  as  far  as  the  health  is  concerned, 
though  its  proximity  to  large  inlets  makes  it  malarious. 

Very  conscientious  and  careful  studies  in  regard  to  the  sanitation  of  these 
points  have  been  made  practically  for  the  port  of  Acajutla,  but  the  work  of  canali- 
zation and  deseccation  are  estimated  to  cost  millions  of  dollars,  for  which  rea- 
son, notwithstanding  the  good  will  of  the  Government,  the  work  has  not  been 
done. 

Prophylactically,  it  has  been  advised  the  destruction  of  the  mosquitoes,  by 
means  of  the  petroleo,  the  equipping  of  the  sleeping  rooms  with  wire  nets,  the 
planting  of  eucalyptus  trees  and  several  other  measures  until  the  above  men- 
tioned works  of  canalization  and  deseccation  can  be  carried  out. 

Every  important  port,  as  previously  stated,  is  fully  equipped  with  large  dis- 
infecting apparatus  under  the  supervision  of  Commissioners  of  the  Board  of 
Health. 

Probably  to  this  organization  and  to  the  energy  employed  in  every  case, 
is  owed  that,  notwithstanding  the  fact  that  El  Salvador  is  in  close  commu- 
nication with  countries  infected  with  yellow  fever  (Panama  and  some  places 
of  the  Mexican  littoral)  and  of  bubonic  pest  (Mazatlan,  Peru  and  San  Fran- 
cisco, California),  none  of  these  terrific  epidemics  have  developed  in  the  Re- 
public. 

SANITATION    OF   THE   CITIES    AND    WATER    SUPPLY. 

The  Government  has  been  always  very  cautious  to  improve  the  sanitary  con- 
ditions of  the  country,  and  I  can  assure  that  if  a  great  number  of  conscientious 
projects  have  not  been  carried  out  as  desired,  it  has  been  on  account  of  the 
financial  crisis  for  some  years  existing  in  the  Republic,  and  this  crisis  is  originated 
by  two  strong  reasons :  El  Salvador  is  exclusively  agricultural  and,  if  not  the 
only,  its  principal  source  of  wealth  is  the  production  of  coffee. 

The  decrease  in  price  of  this  product  in  foreign  markets  and  the  continuous 
fluctuations  in  the  value  of  silver,  determines  this  crisis. 

Notwithstanding  this  sensible  crisis,  in  its  good  will  of  carrying  out  this  work 
as  soon  as  possible,  the  Government  created  the  Board  of  Fomento,  one  for  each 
town  and  resources  for  self-sustaining  have  been  granted  to  each  one  in  order 
to  facilitate  their  effecting  the  sanitation  works  as  soon  as  possible. 

Fortunately  the  idea  was  crowned  with  complete  success.  In  a  very  short 
time  sanitary  and  ornamental  works  have  been  effected  all  over  the  country. 

A  splendid  sewer  system  was  granted  to  the  capital  of  the  Republic,  and  is 
being  completed  with  great  activity,  in  accordance  with  the  incomes  of  the  Board. 
On  these  works  more  than  one  hundred  thousand  dollars  were  spent  last  year, 
v/ithout  taking  into  consideration  what  was  spent  in  the  ornamental  works  of 
the  city. 

The  most  transcendental  and  important  work  heretofore  effected  in  the  capital, 
is  undoubtedly  the  supply  of  water  commenced  but  last  year,  and  which  is  nearly 
completed.  It  was  necessary  to  construct  dry  docks,  pressure  tanks,  etc.,  and  effect 
great  engineering  works  in  order  to  change  the  old  system.  The  Government 
is  about  to  purchase  new  water  pipes  actually  installed  by  private  concerns,  and 
this  will  supply  every  resident  of  the  city,  when  the  whole  work  is  completed,  with 
over  150  litres  of  water  during  the  twenty-four  hours. 

The  following  information  will  give  an  idea  of  the  importance  of  the  work 
in  question : 

As  soon  as  the  estimates  presented  by  Rosing  &  Brothers,  of  London,  were 
accepted,  nine  steamships  were  employed  for  the  transportation  of  19,528  pack- 
ages of  pipe,  with  a  total  weight  of  2,904,508  kilograms  and  valued  at  £24,006-14-8. 
Fire,  irrigating  materials,  etc.,  were  purchased  and  amounted  to  £2,045-17-10, 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  193 

The  expenses  for  accessories,  transportation,  unloading,  etc.,  were  estimated 
over  $40,000.  If  the  engineering  and  labor  expenses  are  added  to  the  above,  it 
will  be  easily  understood  that  over  a  million  dollars  has  been  spent  up  to  this 
date. 

Full  details  with  reference  to  this  work  are  hereby  attached. 

Similar  works,,  although  of  less  importance,  have  and  are  being  effected 
in  almost  every  city  of  the  country.  And,  it  must  be  noted,  that  all  these  works 
are  dependent  of  a  sanitary  plan  previously  conceived. 

Furthermore,  the  Honorable  Legislative  Assembly  voted  in  favor  of  the 
Municipalities  large  sums  for  the  purchase  of  water  pipes  as  well  as  for  the  im- 
provement of  the  sanitary  conditions  of  its  meat  markets,  hospitals,  cemeteries, 
etc.,  etc. 

It  must  be  known  also  that  every  town  is  equipped  with  good  hospitals,  some 
of  them  as  good  as  the  one  existing  in  the  capital,  really  notable,  and  all 
of  them  are  supported  by  the  Government. 

Several  millions  of  dollars  have  been  invested  already  in  the  supply  of  water 
and  sanitation  of  the  cities. 

HEALTH  POLICE  LAWS. 

In  order  to  improve  the  sanitary  conditions  of  the  country,  the  following 
by-laws  have  been  issued  for  the  Health  Police : 

To  avoid  the  damages  caused  by  organic  fermentations,  it  was  resolved  that 
all  sweepings  should  be  incinerated  in  special  cremation  ovens  as  soon  as  they 
were  collected  from  the  streets.  This  work  is  supported  by  the  Municipality. 

It  was  resolved  that  every  unhealthy  establishment  should  be  removed  from 
the  center  of  the  city,  sanitating  a  special  perimeter  of  them. 

It  was  also  resolved  that  the  agents  of  the  Board  should  visit  or  inspect  every 
private  house  in  the  city  once  a  week. 

It  was  imposed  that  the  waste  pipes  should  be  connected  to  the  regular  sewers 
by  means  of  water  closet  plugs,  as  per  design  selected  by  the  Board. 

Regulations  for  the  barber  shops  were  issued  recommending  the  disinfection 
of  all  instruments  and  appliances  used,  as  well  as  the  proper  disinfection  of 
the  hands  and  clothes  worn  by  the  barbers. 

It  was  also  resolved  the  disinfection  from  time  to  time  of  the  churches,  and 
regulations  for  the  disinfection  of  confessionaries  were  duly  issued. 

They  made  it  compulsory  for  every  physician  to  report  to  the  Board  of 
Health,  all  the  cases  of  tuberculosis  found  in  their  daily  practice,  in  addition 
to  the  sicknesses  stipulated  in  the  code  of  laws. 

It  also  imposed  the  periodical  disinfection  of  the  street  cars,  prohibiting 
to  spit  on  the  floors  of  same,  under  heavy  fines. 

Physicians  for  the  sanitary  inspection  of  schools  were  employed  and  a  certain 
amount  of  money  was  voted  for  the  purchase  of  medicines  for  the  poor  children. 

A  concourse  of  physicians  was  opened  for  the  sanitation  of  the  city  of  San 
Salvador,  granting  a  prize  of  some  consideration  to  the  author  of  the  best 
project. 

The  clothing  and  bed  clothes  ol  the  soldiers  were  frequently  disinfected. 

A  Military  Sanitory  was  duly  organized  to  isolate  soldiers  attacked  by  some 
contagious  sickness. 

Two  wards  were  founded  for  the  isolation  of  people  attacked  with  tuber- 
culosis (one  for  male  and  another  for  female)  equipping  them  with  all  that 
was  necessary  for  good  service. 

Annexed  to  the  Slaughter  House  Inspection,  a  Bacteriological  Section  was 
organized  for  the  diagnosis  of  cattle  destined  to  public  consumption. 

It  was  imposed  the  fumigation  of  all  mail  incoming  from  suspicious  countries. 

Regulations  for  bars,  restaurants  and  hotels  were  issued,  stipulating  the 
obligations  of  these  establishments  with  reference  to  the  health  ordinances. 

The  disinfection  of  private  houses  was  imposed  and  to  that  effect  portable  ap- 
paratus of  the  Board  of  Health  were  used  in  contagious  cases.  This  service 
is  obligatory  and  free  to  the  poor. 

The  handling  of  coffee  was  regulated  to  protect  the  public  health. 

The  Animal  Vaccination,  Chemical-Bacteriological  and  Electro-Therapeutic  In- 
stitutes were  established. 

The  Supreme  Board  of  the  Red  Cross,  with  delegates  in  every  city  of  the 
Republic,  was  founded,  so  that  in  case  of  war,  epidemics,  etc.,  it  would  aid  the 
country  as  much  as  possible. 


194  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Several  pamphlets  were  published  and  largely  distributed  showing  the  regu- 
lations to  be  observed  by  the  public  and  the  precautions  to  be  taken  in  case  of 
an  epidemic  to  avoid  the  contagion. 

The  transportation  of  sick  people  in  public  coaches  was  absolutely  prohibited, 
imposing  the  disinfection  of  these  vehicles  from  time  to  time. 

Until  the  Supreme  Government  of  El  Salvador  appoints  the  three  physicians 
or  officials  of  health,  destined  to  form  part  of  the  International  Health  Com- 
mission, informer  of  the  sanitary  conditions  of  the  American  Republics,  it  is 
to  the  Supreme  Board  of  Health  of  the  Republic  whom  concerns  this  duty. 
This  Honorable  Corporation  is  the  supreme  sanitary  authority  of  the  country 
and  it  is  also  supposed  to  inform  about  the  establishment  of  the  Sanitary  In- 
spection Bureaus  of  Montevideo  (sth  clause)  and  about  the  establishment  of 
relations  with  the  International  Office,  organized  in  Washington,  and  with  the 
International  Office  of  Paris,  France. 

The  Supreme  Government  of  El  Salvador  adheres  itself  to  the  International 
Sanitary  Convention  held  in  Washington  on  October  the  I4th,  of  1905,  and  signed 
"ad  referendum"  by  the  Delegates  of  the  Republics  of  Chile,  Costa  Rica,  Cuba, 
Republica  Dominicana,  Ecuador,  United  States  of  America,  Guatemala,  Mexico, 
Nicaragua,  Peru  and  Venezuela,  and  at  the  proper  time  will  take  up  this  matter 
diplomatically. 

REPORTS  OF  THE  DELEGATES  FROM  THE  UNITED 

STATES. 

The  delegation  of  the  United  States  to  the  Third  International  Sanitary  Con- 
vention of  American  Republics  submitted  the  following  reports  provided  for  in 
the  provisional  program  issued  June  17,  1907: 

REPORT  OF  SANITARY  CONDITIONS,  BY  SURGEON-GENERAL 
WALTER  WYMAN,  U.  S.  PUBLIC  HEALTH  AND  MARINE-HOS- 
PITAL SERVICE. 

Since  the  adjournment  of  the  Second  International  Sanitary  Convention  in 
Washington,  October  14,  1905,  the  general  health  of  the  Republic  has  been 
excellent,  and  distinct  advances  have  been  made  in  the  solution  of  various  sani- 
tary problems. 

The  agreement  signed  ad  referendum  at  that  meeting  was  signed  by  the 
President  of  the  United  States  with  the  advice  and  consent  of  the  Senate  on 
May  29,  1906.  The  principles  and  regulations  it  embodies  for  the  international 
control  of  the  quarantinable  diseases  have  been  accepted  and  are  now  in  force. 
The  International  Sanitary  Convention  of  Paris,  which  was  signed  ad  refer- 
endum December  3,  1903,  and  which  was  used  as  an  exemplar  in  preparing  the 
international  sanitary  convention  at  Washington,  was  also  proclaimed  by  the 
President  May  18,  1907.  This  latter  convention,  in  addition  to  codifying  the 
measures  relating  to  the  prevention  of  the  spread  of  plague  and  cholera,  pro- 
vided for  an  International  Sanitary  Bureau  at  Paris.  Since  the  United  States 
had  subscribed  to  this  Convention,  it  was  deemed  important  that  it  should  be 
represented  in  the  International  Sanitary  Bureau  provided  therein. 


nations 

ern  this  new" institution  was  accordingly  prepared  and  submitted  to  the  signa- 
tory powers  with  the  view  to  facilitating  the  exchange  of  the  propositions  of  the 
various  Governments  concerned  regarding  the  organization  in  question. 

An  agreement  was  reached  between  the  French  and  Italian  Governments  to 


of  the  U.  S.  Public  Health  and  Marine-Hospital  Service  representing  the  Gov- 
ernment of  the  United  States.  The  recommendation  of  the  Third  International 
Conference  of  American  States  at  Rio  Janeiro  in  August,  1906,  respecting  the 
establishment  of  relations  between  the  International  Sanitary  Bureau  of  Wash- 
ington and  the  Bureau  Sanitaire  Internationale  of  Paris  were  borne  in  mind 
in  arranging  for  representation  at  this  Conference.  In  addition  to  arranging 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  195 

the  details  of  its  organization,  the  Conference  at  Rome  will  consider  the  ques- 
tion of  its  relation  to  the  International  Sanitary  Bureau  of  Washington. 

Since  the  date  of  the  last  Convention  two  of  the  quarantinable  diseases  have 
been  reported  in  the  United  States.  Smallpox  has  been  reported  annually  in 
different  sections  of  the  country  since  the  epidemic  of  1902.  These  reports 
indicate,  however,  that  there  has  been  a  steady  annual  decrease  in  the  number 
of  cases,  that  the  disease  has  been  of  an  unusually  mild  type,  and  that  there  has 
been  a  marked  decrease  in  the  annual  death  rate  from  this  cause  up  to  the 
present  time. 

The  measures  taken  by  the  Public  Health  Service  and  local  authorities  is 
referred  to  later. 

BUREAU   OF   PUBLIC   HEALTH    OF  THE  UNITED   STATES. 

Five  years  of  administration  under  the  above-mentioned  Act  of  Congress  (July, 
1902)  by  which  a  Bureau  of  Public  Health  with  six  well-defined  divisions  was 
established,  have  demonstrated  the  beneficial  influence  of  this  law,  and,  considered 
with  a  previous  law  establishing  the  Hygienic  Laboratory  "for  the  investigation  of 
infectious  and  contagious  diseases  and  matters  relating  to  the  public  health,"  it 
would  seem  that  Congress  has  established  a  public  health  bureau  with  a  broad 
foundation.  But  more  than  this,  it  has  provided  a  service  whose  personnel  con- 
sists of  trained  medical  and  scientific  officers  devoted  only  to  the  interests  of 
public  health. 

The  Hygienic  Laboratory,  through  its  Advisory  Board,  composed  of  members 
attached  to  other  leading  laboratories,  is  brought  in  touch  with  the  scientific 
work  of  other  institutions  of  the  United  States,  while  the  more  practical  ques- 
tions concerning  the  suppression  of  disease  and  sanitation  are  the  subjects  of 
discussion  with  the  State  boards  of  health,  whom  the  Surgeon-General  is  obliged 
by  law  to  invite  to  meet  in  annual  conference.  The  law  also  provides  for  more 
frequent  conferences. 

Thus  the  service  receives  and  bestows  the  advantages  of  scientific  affiliation, 
and  its  practical  work  is  co-ordinated  with  that  of  the  State  and  municipal  health 
authorities. 

INVESTIGATION   OF   TYPHOID  FEVER   IN   THE   DISTRICT   OF   COLUMBIA. 

One  of  the  most  interesting  and  important  duties  of  the  service  during  the  past 
year  has  been  the  investigation  of  typhoid  fever  in  the  District  of  Columbia. 

A  bulletin  of  360  pages  containing  the  report  on  this  subject  has  been  widely 
recognized  as  a  valuable  addition  to  modern  knowledge  of  the  transmission  of 
this  disease.  It  has  already  been  productive  of  excellent  results  in  that  it  has 
led  to  the  closing  of  wells  in  the  District  and  agitation  of  the  subject  of  the  milk 
supply,  and  of  the  necessary  measures  to  rectify  the  insanitary  conditions  on 
dairy  farms.  It  has  called  into  prominence  a  number  of  factors  in  the  spread  of 
typhoid  to  which  too  little  attention  had  been  paid. 

Though  primarily  an  investigation  of  the  fever  in  the  District  of  Columbia,  the 
report  is  of  practical  value  to  the  administrative  officers  of  all  municipalities. 
It  was  found,  however,  that  to  solve  all  the  problems  connected  with  the  inves- 
tigation, the  board\)f  officers  detailed  for  this  purpose  should  be  continued.  Much 
additional  information  has  been  obtained,  and  will  form  the  subject  of  a  second 
volume. 

Investigations  of  the  same  disease  have  been  made  in  Savannah,  Ga.,  and  Char- 
lotte, N.  C. 

INVESTIGATION    OF    THE    MILK    INDUSTRY. 

Another  and  allied  investigation  is  that  of  the  milk  industry  "from  farm  to 
consumer,"  undertaken  by  special  direction  of  the  Secretary  of  the  Treasury  and 
the  President,  in  which  the  Bureau  has  had  the  co-operation  of  the  Bureau  of 
Animal  Industry  and  the  Bureau  of  Chemistry  of  the  Department  of  Agriculture. 

This  work  has  been  completed  and  will  soon  be  published. 

No  sanitary  subject  is  engaging  greater  attention  in  the  United  States  at  the 
present  time  than  that  of  milk,  which,  more  than  any  other  substance,  unless  it  be 
bread,  is  the  universal  food. 

The  report  contains  some  twenty  articles  bearing  upon  practically  every  phase 
of  the  production  and  transportation  of  milk  from  the  farm  to  the  consumer,  the 


196  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

diseases  which  it  carries,  and  the  most  recent  advances  in  its  bacteriology  and 
chemistry.  To  assure  clean  milk  of  good  quality  is  one  of  the  most  important 
duties  of  health  officers,  to  whom  this  report  will  give  assistance  in  this  endeavor. 

SUPERVISION  OF  VACCINE  AND  CURATIVE  SERUMS. 

The  supervision  of  vaccine  virus,  serums  and  toxins,  under  the  law  of  July  I, 
1902,  has  been  carefully  maintained,  and  it  may  be  said  that  the  effect  of  this  law 
has  been  excellent.  Fourteen  establishments  in  the  United  States,  one  in  Ger- 
many, and  one  in  England,  have  been  critically  inspected,  and  given  licenses  by 
the  Secretary  of  the  Treasury.  The  regulations  require  that  each  of  these  estab- 
lishments shall  be  inspected  every  year,  precedent  to  the  renewal  of  the  license. 
The  inspections  are  made  by  qualified  officers  of  this  service,  who  make  reports 
upon  blank  forms  on  which  are  itemized  every  feature  of  establishments  inspected, 
including  the  equipment,  professional  methods,  and  the  products  for  which  license 
is  desired.  These  products,  some  of  them,  are  obtained  at  the  establishment 
itself,  but  more  frequently  are  bought  in  the  open  market,  and  tested  for  purity 
and  potency  in  the  Hygienic  Laboratory.  The  reports  on  the  Laboratory  investi- 
gation and  from  the  Inspecting  Officer  are  forwarded  to  the  Bureau,  where  they 
are  reviewed  by  the  Bureau  Sanitary  Board.  Based  upon  these  reports  and  the 
recommendation  of  the  Surgeon-General,  the  Secretary  of  the  Treasury  issues 
the  license. 

It  will  be  seen  that  great  care  is  exercised  in  the  enforcement  of  this  law,  which 
is  so  essential  to  insure  purity  and  potency  of  this  most  important  class  of  thera- 
peutic preparations. 

HOOKWORM  DISEASE. 

One  of  the  most  interesting  and  important  subjects  coming  within  the  purview 
of  the  Bureau  has  been  the  prevalence  of  hookworm  disease  as  discovered  by  an 
officer  of  this  service  while  investigating  the  cause  of  the  bad  physical  condition 
of  certain  mill  laborers,  particularly  child-laborers.  The  unfortunate  physical 
condition  of  so  many  of  the  child-workers  in  the  mills  has  been  found  to  be  due 
in  large  measure  to  this  disease.  The  medical  zoologist  of  the  service  was  de- 
tailed to  assist  the  Commissioner  of  Labor  in  his  investigation  of  woman  and 
child  labor  in  the  United  States  under  the  law  of  January  29,  1907. 

A  previous  report  upon  hookworm  disease,  particularly  in  the  South,  was  made 
by  the  zoologist  of  his  service  in  1903,  and  following  his  published  report  the 
matter  was  taken  up  in  Porto  Rico  where  much  of  the  anemia  and  weak  physical 
condition  that  prevailed  among  the  working  classes  was  found  to  be  due  to  this 
disease.  So  important  was  the  matter  that  the  Porto  Rican  Government  made  a 
large  appropriation  and  appointed  a  commission  to  eliminate  the  disease  among 
the  inhabitants,  which  it  has  in  large  measure  accomplished. 

The  full  report  of  this  year's  investigation  has  not  yet  been  received,  but  occa- 
sional reports  show  very  clearly  that  the  prevalence  of  hookworm  disease  in  the 
States  in  which  investigation  has  been  made,  is  sufficient  to  account  in  large 
measure  for  much  of  the  hitherto  unexplained  anemia  and  physical  debility. 
Hitherto  these  cases  have  been  attributed  to  malaria  or  other  debilitating  diseases. 

One  of  the  chief  factors  in  the  spread  of  the  disease  is  soil  pollution. 

TUBERCULOSIS. 

With  regard  to  tuberculosis,  the  suppression  of  which  is  engaging  the  activities 
of  all  civilized  countries,  the  operations  of  the  general  government  relate  to  the 
exclusion  of  immigrants  thus  affected,  the  carrying  out  of  the  President's  Order 
for  the  prevention  of  the  spread  of  this  disease  among  government  employees, 
the  maintenance  of  sanatoria  for  tuberculous  patients  of  the  Army,  the  Navy,  and 
the  Public  Health  and  Marine  Hospital  Service,  and  the  encouragement  in  so  far 
as  the  general  government  may  participate,  of  all  efforts  of  States  and  municipali- 
ties for  its  suppression. 

The  Sanitorium  for  tuberculous  patients  conducted  by  this  service  at  Fort 
Stanton,  New  Mexico,  continues  to  give  good  results,  101  patients  having  been 
discharged  cured  of  the  disease  during  the  past  year. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  197 

HYGIENIC   LABORATORY. 

The  scientific  work  of  the  Hygienic  Laboratory  of  the  service,  as  expressed 
in  the  bulletins  issued  therefrom,  has  excited  widespread  and  favorable  comment 
among  scientists  and  public  health  officials  both  in  this  country  and  abroad.  Plans 
for  the  additional  building  to  cost  $75,000  authorized  by  Congress  at  its  last  ses- 
sion, have  been  prepared,  and  it  is  expected  that  the  new  building  will  be  erected 
within  a  year,  thus  doubling  the  capacity  of  the  laboratory. 

Twelve  qualified  scientists  and  twenty  employees  compose  the  present  working 
force  of  the  laboratory,  but  for  special  investigation  officers  from  the  general 
service  are  detailed  from  time  to  time  as  required. 

PLAGUE  IN    SAN   FRANCISCO. 

A  fatal  case  of  plague  was  reported  to  the  Bureau  from  San  Francisco  in 
May,  1907,  a  little  more  than  three  years  after  the  last  case  had  been  reported 
in  the  outbreak  in  the  same  city,  which,  bginning  in  1900,  was  not  ntirely  era- 
dicated until  February,  1904.  No  case  immediately  followed  this  case  reported 
in  May,  but  on  the  8th  of  August,  three  months  afterwards,  another  case  was 
reported,  and  up  to  November  19,  1907,  there  have  been  in  all  about  100  cases. 
The  origin  of  the  present  outbreak  it  has  been  impossible  as  yet  to  discover. 

A  full  report  upon  this  matter  will  be  included  in  the  report  of  the  service  for 
the  year  ending  June  30,  1908.  A  brief  statement  of  the  transactions  up  to  the 
present  time  (date  of  this  report)  is  here  made. 

The  cases  at  first  appearing  along  the  wharves,  on  the  water  front,  and  in  old 
Chinatown,  were  subsequently  not  confined  to  any  particular  section.  Measures 
were  at  once  taken  to  prevent  the  spread  by  vessels  to  any  other  port,  domestic 
or  foreign,  by  establishing  a  fumigation  service  for  destruction  of  rats  on  all  ves- 
sels leaving  San  Francisco  harbor,  at  the  same  time  requiring  a  careful  inspec- 
tion and  refumigation  if  necessary  at  all  domestic  ports  on  the  Pacific  Coast.  The 
local  and  State  authorities  were  active  in  their  measures  to  suppress  the  disease 
in  San  Francisco,  assisted  by  officers  of  this  Service,  but  on  September  4  a  tele- 
graphic request  was  sent  to  the  President  by  the  Mayor  of  San  Francisco,  re- 
questing the  federal  government  to  take  immediate  charge  of  the  work  of  sup- 
pression. The  Surgeon-General  of  the  Public  Health  and  Marine  Hospital  Ser- 
vice was  instructed  by  the  President  and  the  Secretary  of  the  Treasury  to  comply 
with  the  request.  An  experienced  officer  was  detached  from  his  duty  as  Sanitary 
Director  of  the  Jamestown  Exposition  and  immediately  sent  to  take  charge  of 
measures  in  San  Francisco.  Eight  commissioned  officers  were  sent  to  assist 
him,  and  he  was  authorized  to  appoint  six  acting-assistant-surgeons  and  other 
employees.  Recently,  by  urgent  request  of  the  local  and  State  authorities,  he 
has  been  authorized  to  employ  laborers  and  to  undertake  certain  other  details  of 
the  work  in  further  extension  of  aid  to  the  city.  The  commanding  officer  reports 
that  the  disease  is  diminishing,  that  the  organization  is  complete,  and  the 
work,  which  consists  largely  in  the  destruction  of  rats  and  the  correction  of 
insanitary  conditions,  is  being  pushed  vigorously.  He  states,  however,  and  in 
his  view  the  Bureau  concurs,  that  while  the  disease  may  be  kept  in  check,  it  will 
necessarily  require  a  long  time  for  its  complete  eradication. 

A  case  of  plague  was  reported  in  Seattle,  State  of  Washington,  in  October, 
1907.  The  Governor  of  Washington  and  the  health  authorities  of  the  State  and 
city  requested  the  service  to  take  charge,  and  with  the  approval  of  the  Secretary 
an  experienced  medical  officer  was  sent  to  Seattle  and  has  organized  a  thorough 
system  of  inspection  and  disinfection,  the  State  and  local  boards  of  health  co- 
operating. Two  cases  have  been  reported  from  Seattle,  but  no  case  has  been 
reported  since  October  3oth. 

The  national  quarantine  service  has  required  a  more  than  usual  activity  on  the 
part  of  the  Bureau  during  the  last  year.  There  are  43  national  maritime  quaran- 
tine stations  in  the  United  States,  and  at  these  4,635  vessels  were  inspected  and 
478  disinfected. 

The  Act  of  Congress  approved  June  19,  1906,  provided  for  the  taking  over  of 
the  principal  southern  quarantine  stations  that  were  still  under  State  administra- 
tion, and  under  this  law  the  service  has  acquired  possession  of  all  the  quarantine 
stations  of  South  Carolina  and  the  Mobile  and  New  Orleans  quarantine  stations. 
A  site  has  been  selected  also  at  Galveston,  where  it  will  be  necessary  to  erect  a 
new  station  at  a  cost  of  $100,000. 


198  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

The  national  quarantine  service  now  has  jurisdiction  over  the  whole  of  the 
Pacific  Coast,  the  Gulf  Coast  with  the  exception  of  Texas,  the  Atlantic  Coast 
with  the  exception  of  Baltimore,  New  York,  Boston,  and  a  few  of  the  neighbor- 
ing minor  ports.  These  remaining  State  or  local  stations,  however,  are  required 
to  enforce  the  national  regulations. 

A  very  important  and  interesting  portion  of  the  quarantine  service  is  the  fruit 
port  inspection  service,  medical  officers  being  stationed  in  ten  of  the  principal 
fruit  ports  of  Central  and  South  America,  detailed  by  the  President  in  the  offices 
of  the  American  consuls,  to  insure  such  care  in  the  sanitation  of  the  vessels  as 
to  warrant  their  admission  at  the  southern  ports  of  the  United  States  without 
detention  which  would  destroy  the  fruit.  The  effect  of  these  officers  in  the  fruit 
ports  is  most  salutary,  and  has  enhanced  their  sanitary  condition 

The  quarantine  administration  in  the  Philippines,  under  officers  of  this  service, 
has  been  so  successful  as  to  excite  much  favorable  comment.  The  medical  officer 
in  charge  of  the  national  quarantine  there  is  also  Commissioner  of  Health  of  the 
Islands.  There  has  been  practically  no  plague  or  smallpox  in  the  Philippines 
during  the  past  year.  The  service  conducts  7  maritime  quarantine  stations  in  the 
Philippines,  7  stations  in  the  Hawaiian  Islands,  and  8  in  Porto  Rico. 

In  addition  to  the  medical  inspectors  in  fruit  ports  there  are  medical  officers 
at  the  principal  ports  of  Japan  and  China,  one  at  Calcutta  and  one  at  Naples. 
Besides  their  quarantine  duties,  these  officers  also  examine  departing  emigrants. 

A  great  aid  to  the  administration  of  the  quarantine  service  are  the  bulletins  of 
public  health  (Public  Health  Reports)  issued  weekly  to  quarantine  officers,  con- 
suls, and  sanitarians,  both  at  home  and  abroad.  These  contain  timely  information 
regarding  all  epidemic  diseases  throughout  the  world. 

Besides  this  regular  publication,  the  Bureau  has  transmitted  to  health  officers 
and  others  short  bulletins  on  vaccination,  methods  of  suppressing  smallpox,  precis 
on  scarlet  fever,  diphtheria  and  measles,  a  pamphlet  on  vaccination,  articles  on 
malaria,  on  the  climate  of  New  Mexico,  and  two  works  of  especial  value  by  offi- 
cers of  the  service,  one  on  trachoma  and  one  on  yellow  fever  and  the  mosquito. 
In  these  last  two  volumes  are  included  the  latest  and  most  scientific  considera- 
tions of  the  diseases  to  which  they  relate. 

The  professional  work  connected  with  the  medical  inspection  of  immigrants  has 
been  largely  increased,  1,285,349  immigrants  being  inspected  at  the  ports  of  arrival 
during  the  fiscal  year,  1907.  Many  immigrants,  it  is  true,  are  inspected  at  for- 
eign ports,  but  the  chief  reliance  is  on  the  examination  at  the  port  of  arrival. 
The  last  immigration  act,  approved  February  20,  1907,  imposes  additional  respon- 
sibilities on  the  service,  and  new  regulations  have  been  prepared  to  meet  the 
changes  and  additional  duties  called  for  by  the  new  law.  The  quarantine  officers 
at  the  foreign  ports,  excepting  fruit  ports,  examine  emigrants  in  addition  to 
their  other  duties,  and  the  service  inspection  of  arriving  immigrants  is  carried 
on  in  our  insular  possessions,  namely,  Porto  Rico,  the  Philippines  and  Territory 
of  Hawaii. 

At  Ellis  Island,  New  York,  in  addition  to  the  inspection  service,  the  large  hos- 
pitals are  under  the  medical  supervision  and  professional  care  of  officers  of  this 
service. 

Third.  The  International  Congress  of  Hygiene  and  Demography,  which  meets 
every  three  years,  and  which  in  Berlin,  Germany,  has  been  invited  by  the  Presi- 
dent, through  the  Department  of  State,  as  authorized  by  Act  of  Congress,  to 
hold  the  next  meeting  in  1910  in  Washington.  The  Congress  has  accepted  the 
invitation. 

By  participation  in  these  Congresses  the  service  both  bestows  and  receives 
inspiration  and  information  of  practical  value. 

For  the  performance  of  the  duties  as  outlined  above,  the  personnel  of  the  ser- 
vice numbers  118  commissioned  medical  officers,  3  special  scientists  in  the  Hy- 
gienic Laboratory,  255  acting  assistant  surgeons,  47  pharmacists,  and  851  em- 
ployees. The  Bureau  force  consists  of  6  commissioned  medical  officers,  22  clerks, 
and  6  employees. 

The  total  funds  available  for  use  of  the  service  during  the  fiscal  year  1907 
amount  to  about  $2,800,000. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

REPORT  OF  THE  SANITARY  LAWS  ENACTED  SINCE  OCTOBER 
14,  1905,  PRESENTED  BY  SURGEON-GENERAL  WALTER  WYMAN, 
U.  S.  PUBLIC  HEALTH  AND  MARINE-HOSPITAL  SERVICE. 

Laws  for  the  improvement  01  sanitary  conditions  are  issued  by  both  Congress 
and  the  several  State  legislatures,  and,  in  addition,  ordinances  for  the  control  of 
sanitary  matters  within  municipalities  are  prescribed  by  the  governing  bodies  of 
those  corporations.  Local  sanitary  matters,  though  they  may  be,  and  very  often 
are,  of  great  domestic  importance  in  every  State  in  the  Union,  are  cared  for  by 
the  individual  municipalities  or  States.  On  the  other  hand,  Congress  exercises 
its  legislative  power  regarding  sanitary  matters  as  they  pertain  to  the  seat  of 
Government,  as  they  affect  the  States  in  their  relation  either  to  each  other  or 
to  the  central  government,  and  as  they  are  codified  under  international  agree- 
ments. 

The  most  important  national  legislation  enacted  thus  far  had  for  its  object  the 
prevention  of  the  introduction  of  contagious  diseases  into  the  United  States ;  the 
prevention  of  the  transmission  of  such  diseases  from  one  State  to  another,  and 
the  eradication  of  transmissible  diseases  by  co-operating  and  extending  aid  to 
State  and  municipal  boards  of  health. 

The  experience  of  recent  years  has  demonstrated  the  necessity,  in  the  interest 
of  the  public  health  and  in  the  public  business,  of  uniform  regulations  to  prevent 
the  importation  into  the  United  States  of  yellow  fever  and  other  diseases,  and 
their  spread  from  State  to  State  in  the  unfortunate  event  of  their  introduction. 
In  consequence  of  a  recognition  of  this  fact,  an  Act  was  passed  by  Congress  and 
approved  bv  the  President  June  19,  1906,  further  protecting  the  public  health 
and  making  more  efficient  the  national  quarantine. 

This  Act  provides  for  the  establishment  of  four  additional  national  quaran- 
tine stations  at  points  best  suited  for  the  purpose  to  prevent  the  introduction 
of  yellow  fever  into  the  United  States.  It  prescribes  the  manner  of  selecting 
the  sites,  and  provides  for  the  punishment  by  fine  and  imprisonment  of  all 
persons  entering  the  limits  of  quarantine  grounds  and  anchorages,  or  depart- 
ing therefrom,  in  disregard  of  the  quarantine  laws  and  regulations.  It  also 
provides  for  the  punishment  by  fine  and  imprisonment  of  masters  and  owners 
of  vessels  for  violation  of  the  quarantine  laws  and  the  regulations  promulgated 
thereunder. 

Certain  amendments  to  the  quarantine  regulations  have  been  prescribed  by 
the  Secretary  of  the  Treasury  under  the  authority  conferred  on  him  by  law. 
The  two  amendments  of  most  importance  are  those  of  February  28,  1906,  and 
April  15,  1907.  The  effect  of  the  former  was  to  cause  the  close  quarantine 
season  to  begin  March  15,  instead  of  April  I,  with  regard  to  vessels  from 
ports  known  or  suspected  to  be  infected  with  yellow  fever  and  arriving  at 
Southern  ports,  either  direct  or  via  Northern  ports.  The  latter  prescribes 
regulations  under  which  vessels  from  foreign  ports  with  perishable  cargoes 
of  fruit  are  permitted  to  enter  Southern  ports  in  the  United  States  without 
detention. 

An  Act  of  Congress,  approved  March  4,  1907,  requires  the  inspection  of  all 
cattle,  sheep,  swine,  and  goats,  the  meat  and  meat  food  products  of  which 
are  to  be  used  in  interstate  or  foreign  commerce,  before  they  are  allowed  to 
enter  any  establishment  in  which  they  are  to  be  slaughtered,  the  postmortem 
examination  of  and  inspection  of  the  carcasses  of  all  such  animals,  and  the 
destruction  of  such  carcasses  or  parts  of  carcasses  as  may  be  condemned;  and 
forbids  the  offer  by  any  person  and  the  receipt  by  any  carrier,  for  transpor- 
tation from  one  State  to  another  or  to  any  foreign  country,  of  any  carcasses, 
meat,  or  meat  food  products  which  have  not  been  inspected,  examined,  and 
marked  "Inspected  and  passed."  The  Act  also  provides  for  the  sanitary  in- 
spection of  establishments  in  which  cattle,  sheep,  swine,  or  goats  are  slaugh- 
tered for  use  in  interstate  or  foreign  commerce. 

Congress  also  passed  a  law  which  was  approved  June  30,  1906,  preventing  the 
manufacture,  sale  or  exportation  in  interstate  commerce  of  adulterated  or  mis- 
branded  foods,  drugs  and  liquors. 

During  the  same  session  of  Congress  two  sanitary  police  laws  which  relate 
to  the  District  of  Columbia  were  passed.  The  first,  approved  May  i,  1907,  cre- 
ates a  board  for  the  condemnation  of  insanitary  buildings;  confers  on  this 
board  jurisdiction  and  authority  to  examine  into  the  sanitary  condition  of  all 


2OO  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

buildings  in  the  District,  and  to  condemn  those  buildings  which  are  in  such 
insanitary  condition  as  to  endanger  the  health  or  lives  of  the  occupants  thereof, 
or  persons  living  in  the  vicinity,  and  to  cause  all  such  buildings  to  be  put  in 
sanitary  condition  or  to  be  vacated,  demolished  and  removed.  Provision  is 
made  for  legal  proceedings  on  the  part  of  the  owners  of  the  condemned  build- 
ings, who  are  thus  given  the  right  to  file  objections  against  the  order  of  con- 
demnation. The  other  Act  requires  every  person  in  charge  of  a  patient  suffer- 
ing from  diphtheria,  scarlet  fever,  measles,  whooping  cough,  chickenpox,  epi- 
demic cerebro-spinal  meningitis,  or  typhoid  fever,  to  make  a  report  to  the  health 
officer  stating  the  name  of  the  disease,  the  name,  age,  sex,  and  color  of  the 
patient,  the  school  which  he  or  she  has  attended,  if  any,  and  the  location  of 
the  place  where  the  patient  can  be  found.  On  the  termination  of  the  disease, 
either  in  recovery  or  death,  the  health  officer  is  to  be  notified.  Under  this  law 
the  Commissioners  of  the  District  are  authorized  to  make  such  regulations  as 
may  be  necessary  to  prevent  the  spread  of  the  diseases  named.  Both  of  these 
laws  apply  only  to  the  District  of  Columbia,  and  must,  therefore,  be  regarded 
as  local  rather  than  national  in  their  application. 

The  Fifty-ninth  Congress  during  its  first  session  also  made  provision  for 
an  investigation  as  to  the  prevalence  of  tuberculosis  among  the  Indians,  and 
the  desirability  of  establishing  a  sanatorium  for  the  treatment  of  Indians 
afflicted  with  this  disease,  as  follows: 

That  the  Commissioner  of  Indian  Affairs,  under  the  supervision  of  the  Secre- 
tary of  the  Interior,  is  hereby  authorized  to  investigate  and  report  to  Congress 
upon  the  desirability  of  establishing  a  sanatorium  for  the  treatment  of  such 
Indians  as  are  afflicted  with  tuberculosis,  and  to  report  upon  a  location  and 
the  cost  thereof,  and  also  upon  the  feasibility  of  utilizing  some  present  Gov- 
ernment institution  therefor ;  said  report  to  include,  as  far  as  possible,  the  extent 
of  the  prevalence  of  tuberculosis  among  Indians. 

With  a  view  of  preventing  the  spread  of  tuberculosis  among  employees  of 
the  various  Government  buildings,  offices  and  workshops,  the  President  issued 
an  Executive  Order,  dated  February  28,  1906,  providing  for  the  inspection  of  the 
Government  offices  and  workshops,  the  preparation  of  pamphlets  of  instruc- 
tion, regulations,  and  anti-spitting  notices. 

Provision  was  also  made  in  this  Executive  Order  for  the  examination  of 
persons  suspected  of  being  afflicted  with  tuberculosis,  such  examinations  to  be 
made  in  laboratories  at  Government  expense. 

Since  October  14,  1905,  many  important  laws  have  been  enacted  by  the 
various  State  legislatures  for  the  protection  of  the  public  health  and  the  im- 
provement of  sanitation  within  their  jurisdiction. 

These  measures  are  of  wide  applicability  and  meet  needs  in  the  several  States 
for  which  they  are  intended.  Not  less  than  eight  States  have  enacted  laws 
preventing  the  manufacture,  sale  or  transportation  of  food,  drugs  and  liquors 
within  their  borders.  A  number  have  passed  laws  relating  to  the  control  of 
water  supplies  and  sewage.  Provision  has  been  made  for  a  number  of  State 
sanatoria  for  the  treatment  of  tuberculosis.  Acts  have  been  passed  in  New 
York  and  New  Jersey  providing  for  the  abolition  of  mosquito  breeding  areas 
and  for  draining  swamps  and  other  low  lands. 

A  legal  enactment  in  Mississippi  requires  the  State  Board  of  Health  to  pre- 
pare rules  and  regulations  for  the  proper  disinfection  and  sanitation  of  public 
buildings,  railroad  depots,  and  all  railroad  coach  and  sleeping  cars  operated  in 
the  State.  Other  enactments  of  the  various  State  legislatures  relate  to  the 
collection  of  statistics,  the  increased  power  of  boards  of  health,  the  control  of 
conditions  under  which  meats  and  milk  are  produced,  and  regulation  of  the 
registration  of  medical  practitioners. 

ABSTRACT  OF  REPORTS  ON  THE  SANITATION  OF  AMERICAN 
PORTS  PRESENTED  BY  DR.  WALTER  WYMAN,  OF  THE 
UNITED  STATES  DELEGATION. 

Official  reports  received  from  various  municipalities  located  along  the  coasts 
of  the  United  States  indicate  that  steady  progress  is  being  made  in  the  im- 
provement of  sanitary  conditions.  The  financial  burden  accompanying  this 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  2OI 

work  is  assumed  by  the  interested  municipality  or  State.  Government  improve- 
ments undertaken  in  the  interest  of  interstate  and  foreign  commerce  and  the 
establishment  and  maintenance  of  national  quarantine  stations  are  the  func- 
tions of  the  national  government.  The  control  of  water  supplies,  the  dis- 
posal of  sewage,  the  paving  of  streets,  the  provisions  for  housing,  etc.,  have 
thus  far  been  administered  by  local  authorities.  The  extent  of  this  work  in 
a  number  of  the  cities  is  outlined  in  the  following  abstracts  of  reports  submitted 
by  officers  of  the  U.  S.  Public  Health  and  Marine  Hospital  Service. 

BALTIMORE,  MD. 

The  only  system  of  drainage  in  operation  in  the  city  of  Baltimore  at  the 
present  time  is  that  for  the  disposal  of  surface  water.  These  drains  empty 
into  a  small  stream  which  discharges  into  the  harbor.  Owing  to  the  topography 
of  the  city  they  are  efficient  except  at  times  of  maximum  precipitation  when 
low  lying  portions  of  the  city  may  be  temporarily  flooded.  These  storm  drains 
also  receive  the  sewage  from  dwellings  provided  with  water  closets,  about  one- 
third  of  the  houses  disposing  of  their  sewage  in  this  way.  Under  an  enabling 
Act  of  the  Maryland  Legislature,  the  city  has  incurred  a  bonded  debt  of 
$12,000,000  for  the  purpose  of  constructing  a  complete  system  of  sewers  and 
sewage  disposal.  This  work  is  well  under  way  and  will  probably  be  completed 
within  seven  years.  The  system  will  comprise  about  four  hundred  miles  of  main 
and  branch  sewers  with  disposal  works  located  on  Back  River.  The  system  of 
disposal  as  contemplated  will  consist  of  treatment  in  septic  tanks,  followed  by 
sprinkling  over  filter  beds  of  broken  stone  and  final  purification  by  intermittent 
filtration  by  artificial  sand  filters.  The  effluent  will  be  discharged  into  Back  River 
14  miles  from  its  outlet  into  Chesapeake  Bay. 

The  water  supply  is  obtained  from  two  sources,  the  water  being  received 
in  a  system  of  settling  reservoirs  with  an  aggregate  capacity  of  approximately 
one  billion  gallons.  The  lower  levels  of  the  city  are  supplied  by  gravity;  the 
high  service  is  provided  for  by  three  pumping  station^  and  the  necessary  stand- 
pipes;  the  capacity  of  the  settling  basins  is  barely  sufficient  for  present  needs, 
and  the  watersheds  are  subject  to  pollution.  It  is  understood  that  the  water 
department  proposes  to  ask  for  an  appropriation  of  $5,000,000  for  the  purchase 
of  the  entire  watershed  of  the  Gunpowder  River  in  order  to  protect  it  from 
pollution  and  for  the  erection  of  a  reservoir  of  twenty  billion  gallons  capacity. 
Should  this  plan  be  carried  out,  the  supply  from  one  of  the  present  sources, 
the  water  shed  of  which  is  well  polluted,  will  be  discontinued. 

The  sanitation  of  dwellings  will  be  provided  for  as  far  as  sewage  disposal 
is  concerned  upon  completion  of  the  new  sewerage  connection,  and  their 
sewage  is  received  in  cesspools  and  privy  vaults.  City  ordinances  require  that 
the  latter  be  ventilated  and  made  water  tight. 

Paving  of  a  modern  and  sanitary  character  is  being  slowly  substituted  for 
the  Belgian  blocks  and  cobblestones  now  in  use. 

Mosquito  extermination  has  been  inaugurated  by  the  Health  Department. 
The  measures  consist  of  the  filling  or  draining  of  collections  of  water  and  of 
periodical  oiling  when  other  methods  cannot  be  employed. 

NORFOLK,  VA. 

The  Health  Commissioner  of  the  City  of  Norfolk,  in  a  report  dated  October 
5,  1907,  states  that  for  the  year  ending  September  30,  1907,  the  following  diseases 
occurred:  Diphtheria,  159;  Scarlet  Fever,  69;  Smallpox,  50. 

The  water  supply  is  derived  from  lakes  located  about  4^  miles  from  the  city. 
The  water  flows  into  a  concrete  basin,  is  treated  at  the  intake  with  alum  solution 
at  the  rate  of  %  grains  to  the  gallon,  and  also  treated  by  sand  filtration.  The 
sewage,  for  the  most  part,  is  removed  through  house  drains  connecting  with 
main  sewers,  and  by  means  of  a  pumping  system  is  carried  to  various  stations, 
and  from  there  pumped  into  the  river.  The  city  is  generally  sewered,  but  few 
surface  closets  being  in  use,  and  these  are  confined  mainly  to  the  outlying  dis- 
tricts. 

The  collection  and  disposal  of  garbage  is  carried  on,  daily  collections  being 
made  in  summer  and  disposed  of  by  cremation. 

An  anti-mosquito  campaign  has  been  carried  on  during  the  present  year  with 
favorable  ^results,  and  the  Department  of  Health  has  been  active  in  other  lines 
of  sanitation. 


2O2  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

SAVANNAH,  GA. 

The  water  supply  is  obtained  from  artesian  wells,  and  is  abundant.  The 
water  though  hard  is  free  from  contamination. 

The  sewage  is  removed  by  means  of  two  systems  of  sewerage,  one  for  surface 
drainage  and  the  other  for  house  drainage.  These  systems  are  protected  by 
city  ordinances  and  enforced  by  supervision  and  inspection. 

MOBILE,  ALA. 

The  water  supply  is  obtained  from  two  sources — small  creeks  fed  by  springs. 
Both  stations  are  provided  with  reservoirs  at  an  altitude  of  about  210  feet  above 
the  city.  Each  reservoir  has  a  capacity  of  about  ten  million  gallons. 

The  drainage  and  sewerage  system  covers  about  75  per  cent  of  the  area  of  the 
city.  As  groups  of  houses  are  built,  drains  and  sewers  are  constructed,  and 
property  owners  are  compelled  by  law  to  make  the  necessary  connections.  Dur- 
ing the  year  ended  March  15,  1907,  1,373  feet  of  8-inch  sewers  were  laid,  and  at 
present  about  500  feet  are  under  construction.  The  garbage  is  collected  by  the 
city  twice  daily  where  necessary,  at  all  other  points,  once  a  day.  This  garbage 
is  dumped  and  covered  with  earth,  notwithstanding  the  recommendation  of  the 
city  health  officer  for  the  construction  of  a  cremation  plant.  Inspections  of 
dwellings  and  premises  are  required  by  city  ordinances. 

GALVESTON,  TEX. 

In  September,  1900,  Galveston  was  visited  by  a  severe  tropical  storm  and  a 
very  large  portion  of  the  city  was  swept  away.  Immediately  thereafter,  its 
citizens  began  rebuilding  the  city.  The  entire  Gulf  front  was  protected  by  a 
sea-wall  of  concrete,  a  portion  of  which  was  constructed  by  the  national  gov- 
ernment. Coincident  with  this  improvement  was  the  raising  of  the  grade  of  the 
entire  city.  This  grade  raising,  which  at  the  present  time  is  more  than  three 
quarters  completed,  was  done  by  means  of  specially  constructed  dredges  which 
took  sand  from  the  channel  and  brought  it  through  a  canal  dug  for  the  pur- 
pose, from  where  it  was  pumped  out  over  the  city,  raising  the  grade  from  two 
to  eight  feet. 

A  sewerage  system  was  also  started,  and  is  now  practically  completed  in  all 
parts  of  the  city  where  the  grade  has  been  raised. 

The  water  supply  of  Galveston  is  largely  artesian,  the  well  being  located 
on  the  main  land  of  Texas,  and  the  water  is  conducted  to  the  city  by  means  of 
pipes. 

A  campaign  against  mosquitoes  has  been  waged  by  the  city  health  authorities 
with  marked  results. 

In  submitting  the  following  report  upon  the  sanitary  work,  including  drainage, 
sewering,  water  supply,  etc.,  completed,  under  way,  or  to  be  done  in  the  City  of 
New  Orleans,  Surgeon  J.  H.  White  stated  that  the  information  was  based  upon 
data  given  him  by  the  city  officials  in  addition  to  his  own  observations. 

SEWERAGE,  WATER  SUPPLY  AND  DRAINAGE. 

The  three  systems  of  sewerage,  water  supply  and  drainage  are  being  or  are 
to  be  constructed  and  operated  by  the  Sewerage  and  Water  Board  of  the  city 
of  New  Orleans. 

DRAINAGE    SYSTEM. 

The  drainage  system  was  started  in  1896,  and  ^  was  sufficiently  advanced  by 
1900  to  begin  operation  and  to  provide  for  lowering  the  level  of  water  in  the 
main  drainage  arteries  to  a  depth  of  from  10  to  15  feet  below  the  surface  where 
they  used  to  stand  nearly  full  of  water  at  all  times.  The  effect  of  this  was 
to  bring  about  a  greatly  reduced  soil  saturation,  and  coincident  with  it  came  a 
prreatly  decreased  death  rate.  By  1902  nearly  all  of  the  drainage  construction 
that  available  funds  would  permit  had  been  completed,  although  $700,000  has  since 
been  spent  in  absolutely  essential  extensions  and  improvements  in  the  drainage 
system,  making  the  total  expenditures  upon  said  system  to  date  about  $5,400,000, 
of  which  $4.600.000  is  from  the  Sewerage  and  Water  Board  funds.  Nearly  the 
whole  city  is  now  receiving  the  benefits  of  the  drainage  system  to  the  extent 
that  all  existing  canals,  drains  and  gutters  are  kept  pumped  down  practically  con- 
tinuously. Certain  sections  have  not  the  canals  which  they  are  eventually  in- 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  2O3 

tended  to  have,  and  only  a  small  portion  of  the  sub-drainage  leading  into  these 
canals  has  as  yet  been  constructed.  Further,  the  present  pumping  capacity  is 
less  than  half  of  what  it  should  be  to  keep  ahead  of  the  canal  deliveries  during 
occasional  heavy  storms,  which,  of  course,  results  in  the  flooding  of  some  of 
the  low  areas  of  the  city  until  the  pumps  can  get  ahead  of  the  rain  fall.  Besides 
this,  it  is  intended  eventually  to  construct  an  intercepting  canal  on  Broad  street 
that  will  be  adequate  to  send  the  dry  weather  and  small  storm  drainage  flow 
to  Lake  Borgne,  14  miles  below  the  city,  only  discharging  the  surplus  water  of 
heavy  storms  to  Lake  Ponchartrain,  thus  preventing  its  pollution. 

Again,  many  large  canals  are  already  masonry  lined,  while  some  are  still  only 
excavated  in  earth.  Eventually,  all  must  be  masonry  lined  and  all  streets 
must  be  sub-drained  into  them.  To  do  all  of  this  work  now  over  the  present 
city  area  of  25,000  acres  would  cost  an  amount  beyond  the  possible  consideration 
of  the  present  population,  though  as  the  city  grows  in  wealth  and  population  it 
will  be  able  to  carry  forward  the  works  required  to  keep  pace  with  this  growth. 

There  is  now  authorized  a  further  bond  issue  of  $8,000,000,  of  which  about 
$6,000,000  is  to  be  expended  in  further  improvements  and  extensions  of  the 
main  drainage  system,  intercepting  canal  to  Lake  Borgne,  a  great  increase  in 
power  and  pumping  capacity  and  the  masonry  lining  of  a  number  of  canals  in 
areas  where  the  development  already  warrants  this  improvement.  So  soon  as 
financial  conditions  will  enable  the  Board  to  float  this  bond  issue,  this  further 
work  will  be  undertaken,  and  this  expenditure  will  bring  the  main  drainage 
svstem  into  very  good  condition.  It  will  not  entirely  prevent  flooding  over 
sidewalks  for  short  periods  during  unusually  heavy  showers,  or  shallow  accu- 
mulations of  water  in  low  areas  of  the  city  when  such  storms  occur,  as  that  of 
last  April,  when  over  8  inches  of  water  fell  in  12  hours,  but  it  will  give  New 
Orleans  a  drainage  system  that  will  cope  with  any  rain  fall  which  would  not 
give  about  equal  trouble  in  practically  any  other  large  city. 

SEWERAGE   SYSTEM. 

The  sewerage  construction  was  started  in  1903.  All  qf  the  main  sewers  and 
pumping  stations  are  constructed  and  in  operation,  and  about  250  miles  of 
sewers  are  completed,  the  last  50  miles  being  not  yet  finally  cleaned  out  and 
accepted  from  the  contractors,  but  will  be  within  a  month  or  so.  There  still 
remain  about  no  miles  of  sewers  to  build  to  cover  the  whole  populated  area 
of  the  city  and  sewer  over  400  miles  of  streets.  Bids  were  received  for  these 
sewers  in  September,  to  be  completed  by  the  end  of  1908,  but  were  all  rejected 
because  they  were  considered  too  high.  ^  This  may  delay  slightly  the  completion 
of  the  last  portion  of  the  sewers,  but  in  the  mean  time  connections  are  being 
permitted,  or  soon  will  be  permitted,  to  the  entire  250  miles  already  constructed, 
and  the  remaining  no  miles  will  either  be  let  to  contract  or  be  built  independent 
of  any  contract  as  promptly  as  possible. 

All  of  the  constructed  sewers  are  draining  constantly  to  the  pumping  sta- 
tions, and  about  10,000,000  gallons  per  day  of  ground  or  seepage  water  is  being 
pumped  from  them  into  the  Mississippi  River.  This  is  having  a  very  marked 
effect  in  further  reducing  the  saturation  of  the  soil. 

The  Board  is  not  yet  in  a  position  to  force  sewerage  connections,  both  because 
the  water  works  system  is  not  completed  and  because  it  is  not  in  funds  (until 
the  $8,000,000  bond  issue  is  floated)  to  make  the  connections  from  the  sewer  and 
water  mains  to  the  property  line,  which  the  law  requires  shall  be  done  at  the 
cost  of  the  board.  Many  people,  however,  are  making  the  sewer  connections 
at  their  own  expense,  and  about  700  connections  are  now  in  use  and  operating 
satisfactorily. 

The  total  cost  of  the  sewerage  system,  exclusive  of  house  connections,  will 
be  about  $5,500,000. 

WATER  WORKS  SYSTEM. 

About  160  miles  of  water  mains  are  already  laid,  the  water  purification  and 
pumping  station  work  is  all  under  contract  and  well  advanced,  contracts  are 
now  outstanding,  or  about  to  be  signed  up,  for  the  completion  of  the  water 
mains  to  bring  the  total  mileage  to  about  450  miles,  which  will  serve  the  present 
populated  area  of  the  city. 


2O4  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

It  is  intended  to  furnish  a  clear  filtered  water  that  will  be  absolutely  good  and 
safe  for  all  uses. 

The  water  purification  and  pumping  station  contract  will  aggregate  about 
$2,000,000,  the  pumping  machinery  contract  about  $500,000,  and  the  distribution 
system,  etc.,  about  $4,200,000,  or  a  total  of  about  $6,700,000. 

All  contracts  call  for  completion  by  or  about  the  end  of  1908,  and  there  seems 
to  be  no  reason  why  the  work  should  not  be  ready  for  operation  at  about  that 
time. 

Work  on  the  water  works  system  was  not  started  until  1905,  because  it  was 
necessary  to  save  interest  on  undelivered  bonds  and  thus  build  up  the  construc- 
tion fund  through  a  period  extending  to  the  end  of  1908,  to  be  able  to  cover 
the  ground  at  all  with  the  sewerage  and  water  works  systems,  and  the  latter 
being  of  a  nature  where  expenditures  could  be  made  rapidly  was  left  until  there 
was  barely  time  to  complete  it,  in  order  to  gain  as  much  saving  of  interest  as 
possible. 

Figures  above  stated  are  closely  approximate. 

There  is  but  little  in  the  way  of  rules  adopted  as  to  drainage  connections  from 
houses,  and  this  matter  is  only  partly  under  the  jurisdiction  of  the  Sewerage  and 
Water  Board,  since  local  subdrainage  pipes  are  constructed  by  the  city,  on  plans 
subject  to  the  approval  of  the  Sewerage  and  Water  Board,  and  most  drainage 
connections  are  into  such  pipe.  Eventually  a  set  of  rules  as  to  sewerage,  water 
and  drainage  connections  should  be  worked  out  and  adopted  jointly  by  the 
Sewerage  and  Water  Board,  the  City  Council  and  the  City  Board  of  Health. 
At  present  it  is  under  Sewerage  and  Water  Board  rules,  copy  of  which  is  sent 
herewith,  and  results  are  being  watched  with  a  view  to  perfecting  and  com- 
pleting them  (the  rules)  before  asking  for  such  joint  action  as  will  make  them 
binding  as  to  plumbing  even  before  connections  are  made  with  the  sewers,  and 
as  to  drainage,  whether  the  connection  be  into  a  street  gutter,  a  sub-surface 
drain  laid  by  the  city,  or  into  one  of  the  drainage  canals  constructed  by  the 
Sewerage  and  Water  Board. 

PAVEMENT. 

Some  desultory  pavement  has  been  laid  throughout  the  city,  but  no  sys- 
tematized or  extensive  work,  and  this  is  unfortunate  because,  for  protection 
against  yellow  fever,  not  only  are  sewerage,  drainage  and  water  supply  needed, 
but  pavement  as  well,  and  the  city  cannot  be  considered  in  a  position  to  relax 
her  vigilance  in  the  slightest  degree  until  all  of  these  have  been  put  in. 

Effort  was  made  to  secure  from  the  City  Engineer  and  the  City  Board  of 
Health,  any  information  obtainable  with  regard  to  this  as  well  as  the  matter  of 
mosquito  elimination,  but  without  success. 

MOSQUITO   DESTRUCTION. 

It  is  gratifying  to  state  that  the  present  City  Board  of  Health  has  carefully 
and  consistently  carried  out  the  supervision  of  premises  to  see  ^that  the  law 
providing  for  the  screening  of  all  water  containers  and  the  elimination  of  all 
pools  and  puddles  is  put  into  effect,  and  this  law,  which  was  put  on  the  city's 
statute  books  at  the  instance  of  former  City  Health  Officer  Kohnke  and  myself, 
is  a  most  complete  and  satisfactory  ordinance. 

This  report  would  have  been  submitted  much  earlier  but  for  the  fact  that  I 
have  waited  more  than  a  month  in  the  hope  that  I  might  obtain  from  the  City 
Engineer  and  the  City  Board  of  Health,  the  same  definite  and  satisfactory  data 
which  were  given  me  by  the  Sewerage  and  Water  Board.  In  this,  however, 
I  was  disappointed,  and  regarding  the  intention  to  pave  the  city,  I  can  only  say 
that  I  have  been  personally  assured  by  the  City  Engineer  that  he  is  earnestly 
recommending  the  thorough  paving  of  all  the  city  as  soon  as  the  funds  are 
available. 

REPORT  ON  THE  SANITARY  IMPROVEMENTS  OF  THE  CITY  OF 
MOBILE,  AND  THE  NEW  SANITARY  LAW  OF  THE  STATE  OF 
ALABAMA.  PRESENTED  BY  DR.  RHETT  GOODE,  DELEGATE 
FROM  THE  UNITED  STATES. 

In  compliance  with  a  suggestion  from  Surgeon  General  Wyman,  Chairman,  and 
in  accordance  with  your  provisional  program,  I  have  concluded  to  make  a  brief 


THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

report  under  the  first  section  (b),  that  is,  "A  report  on  the  condition  of  the  port 
of  Mobile,  mentioning  the  works  which  have  been  executed  and  those  in  course 
of  construction.  Also  a  brief  history  of  the  water  supply,  sewerage,  plumbing 
and  house  drainage." 

Under  paragraph  (d)  I  shall  submit  in  full  a  report  of  the  sanitary  police 
laws  which  have  been  issued  by  the  State  of  Alabama  and  the  City  of  Mobile, 
since  the  fourteenth  of  October,  1905. 

The  city  of  Mobile  is  situated  at  the  mouth  of  Mobile  River  where  it  empties 
into  Mobile  Bay,  principally  on  the  west  side,  and  thirty-three  miles  from  the 
Gulf  of  Mexico.  It  has  a  population  of  over  50,000  and  covers  an  area  of  seven- 
teen square  miles.  The  average  rise  of  the  tide  water  is  two  feet  two  inches. 
The  surface  of  the  ground  is  nearly  level  for  some  distance  from  the  water 
and  then  gradually  rises  to  a  height  of  some  two  hundred  feet  at  a  point  six 
miles  west  of  the  water  front.  In  a  direction  north,  at  a  distance  of  two  miles 
we  have  an  abrupt  rise  of  over  fifty  feet. 

There  has  been  a  complete  system  of  water  works  constructed  which  gives 
to  the  citizens  a  bountiful  supply  of  pure  water  which  has  been  analyzed  by  the 
Bureau  of  Public  Health  at  Washington,  D.  C,  and  found  to  be  free  of  disease 
germs.  This  water  supply  is  obtained  from  clear  running  creeks  located  a  dis- 
tance between  eight  and  ten  miles  from  the  center  of  the  city.  They  have  im- 
pounding reservoirs  and  large  pumps  which  supply  the  city  daily  with  over  nine 
million  gallons  of  water  for  consumption.  There  are  at  the  present  time  10,383 
houses  supplied  with  the  water  for  use.  There  is  a  total  mileage  of  water  mains 
amounting  to  154  and  5-8  miles.  There  is  no  water  used  in  the  limits  of  the  city 
obtained  from  cisterns  or  wells. 

A  complete  system  of  sewerage  which  covers  seven-eighths  of  the  entire  city 
has  been  constructed  and  in  operation  for  the  past  eight  years.  This  sewerage 
system  extends  from  the  eastern  to  the  western  limits  of  the  city  and  empties 
into  the  river  at  a  point  below  the  low  tide  water  mark  and  is  by  the  current 
of  the  river  carried  out  into  the  bay  and  thence  to  the  Gulf  of  Mexico. 

The  house  drains  and  closets  are  connected  with  this  general  sewerage  system. 
Municipal  laws  have  been  passed  covering  the  management  of  the  water  supply, 
the  sanitary  sewerage  and  sanitary  plumbing  of  the  residences  of  the  city, 
all  of  which  are  submitted  as  a  part  of  this  report.  The  soil  of  the  City  of 
Mobile  is  sandy  and  very  porous.  After  the  very  severest  rains  it  requires  only 
a  short  period,  two  or  three  days,  for  the  streets  of  the  city  to  become  perfectly 
dry. 

At  the  present  time  we  have  14  miles  of  paved  streets,  composed  of  asphalt, 
bitulithic,  brick,  belgium  and  wooden  blocks.  Five  miles  are  under  contract  for 
completion.  Where  the  streets  have  been  paved,  the  storm  water  from  the  roofs 
of  houses  and  the  surface  of  yards  and  sidewalks,  are  disposed  of  through  the 
storm  sewers  which  are  constructed  in  connection  with  the  paving.  At  the 
points  where  the  city  is  not  payed,  this  water  is  allowed  to  pass  off  through  the 
open  street  gutters  natural  drainage. 

I  submit  a  copy  of  an  ordinance  to  regulate  the  sale  of  milk  in  the  City  of 
Mobile.  This  ordinance  has  been  in  execution  for  more  than  a  year  and  we 
have  found  that  it  has  been  of  great  service  in  securing  to  the  people  a  pure  and 
better  supply  of  milk. 

The  milk  inspector  in  examining  the  herds  of  the  different  dairymen  of  the 
city  found  a  large  number  of  cows  affected  with  tuberculosis.  These  have  been 
eliminated  and  the  system  is  working  to  the  greatest  satisfaction. 

I  also  submit  an  ordinance  passed  by  the  city  relative  to  the  destruction  of 
mosquitoes  and  declaring  standing  water  a  nuisance. 

MOSQUITOES. 

Ordinance  adopted: 

Section  I.  Pools  and  sinks  io  be  oiled. — Between  March  first  and  Novem- 
ber thirtieth,  in  each  year,  the  owner  or  occupier  of  every  house,  or  lot  within 
the  City  of  Mobile,  shall  at  least  once  a  month,  put  into  every  pool,  or  sink 
which  is  open,  or  in  which  there  is  any  opening  or  outlet,  kerosene  oil,  at  the 
rate  of  one  ounce  for  each  fifteen  square  feet  of  surface  of  such  pool  or  sink, 
and  that  quantity  for  any  surface  less  than  fifteen  feet. 

Section  2.  Rain  barrels,  water  in  to  be  oiled. — One-half  of  an  ounce  of  kero- 
sene  oil  shall,  during  the  same  period  of  time,  be  put  by  such  owner,  or  tenant, 


206  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

into  every  open  barrel,  or  hogshead,  kept  for  the  purpose  of  collecting  rain 
water,  and  water  shall  be  taken  from  such  barrel,  or  hogshead,  only  by  a  spigot 
of  wood,  or  metal,  placed  as  near  as  convenient  to  the  bottom  of  the  barrel  or 
hogshead. 

Section  3.  Street  Superintendent  to  oil  ditches,  etc. — The  Superintendent  of 
streets  shall,  during  the  same  period  of  time,  put  crude  petroleum  oil  on  all 
stagnant  water  within  the  limits  of  the  City  of  Mobile,  in  battery  ditches,  cis- 
terns, drains  and  gutters,  located  upon  the  streets  or  upon  property  owned  by 
the  city,  at  the  expense  of  the  city,  at  the  rate  of  two  ounces  to  every  fifteen 
square  feet  of  surface,  once  every  two  weeks. 

Section  4.  Police  to  enforce  ordinance;  penalty  for  failure  to  comply  with 
ordinance. — It  is  the  duty  of  the  police,  by  proper  inspection,  to  see  that  the 
provisions  of  this  ordinance  are  complied  with,  and  every  person  failing  or 
refusing  to  comply  with  its  provisions  shall  be  fined  by  the  Recorder  not  less 
than  five  dollars  nor  more  than  twentv  dollars  for  each  offense. 

NUISANCES. 

Permitting  water  to  stand  in  tub,  or  other  receptacle  on  premises,  for  more  than 
twenty-four  hours,  penalty  for. —  No  person,  owning  or  occupying,  or  being  in 
possession  of  any  house,  shed  or  other  building,  or  lot  of  land,  in  the  city  of 
Mobile,  shall  permit  or  allow  water  to  stand  in  any  tub,  bucket,  can,  bottle  or 
other  receptacle  whatever  in  such  houses,  shed  or  other  building,  or  upon 
such  lot  of  land,  for  a  period  of  time  exceeding  twenty-four  hours.  Any  violation 
of  this  section  shall  be  punished  by  a  fine,  to  be  imposed  by  the  Recorder,  of 
not  less  than  two  dollars  and  fifty  cents,  nor  more  than  fifty  dollars  for  such 
offense. 

Pond  or  standing  water  on  premises,  is  nuisance,  abatement  of. — Upon  com- 
plaint being  made  before  the  Recorder  by  the  Health  Officer  that  a  pond,  or 
other  standing  water  remains  upon  the  land  or  lot  of  any  citizen,  corporation 
or  association  within  the  corporate  limits  of  the  City  of  Mobile,  and  that  the 
same  is  dangerous  to  the  health  of  the  people  of  said  city,  and  a  nuisance,  the 
Recorder  shall  cause  a  warrant  to  be  issued  commanding  said  person,  corpora- 
tion or  association,  to  appear  before  him  to  answer  said  complaint.  And  the 
Recorder  shall  hear  the  evidence  in  the  case,  and,  if  satisfied  that  said  com- 
plaint is  well  founded,  order  and  require  said  nuisance  to  be  abated  within  a 
period  of  time,  not  exceeding  twenty  days. 

The  present  Legislature  of  the  State  of  Alabama  has  enacted  the  following 
liealth  laws : 

1.  An  act  to  reconstruct  the  law  regulating  the  practice  of  medicine  in  this 
State. 

2.  An  act  increasing  the  annual  appropriation  to  the  State  Board  of  Health. 

3.  An  act  providing  for  the  establishment  of  a  Tuberculosis  Sanatorium. 

tAn  act  amending  the  general  public  health  laws  in  the  following  particulars : 
i)  Requiring  the  following  named  diseases  to  be  reported  to  health  officials, 
local    and    State:       Leprosy,   cholera,   typhus    fever,    cerebro-spinal   meningitis, 
yellow   fever,   scarlet  fever,   bubonic  plague,   hydrophobia,   glanders,   small-pox, 
diphtheria,  pulmonary  tuberculosis,  typhoid  fever,  Chagris  fever,  beri-beri. 

(b)  Providing  more  fully  than  heretofore  for  the  collection  of  vital  and  mor- 
tuary statistics. 

(c)  Defining  more  fully  than  heretofore  the  duties  of  county  health  officers. 

(d)  Providing  an  increase  of  salaries  for  county  health  officers. 

(e)  Prescribing  the  duties  of  municipal  health  officers  and  providing  that  their 
salaries  shall  be  fixed  by  the  respective  municipalities. 

(f)  Providing  better  than  heretofore  for  the  disinfection  of  infected  houses. 

(g)  Prohibiting  the  leasing  or  selling  of  a  house  infected  with  any  of  the 
diseases  named  above  under  (a)  without  giving  notice  of  such  infection  to  the 
proposed  lessee  or  purchaser. 

(h)  Requiring  judges  of  probate  to  report  all  marriages  to  the  State  Board  of 
Health. 

(i)  Requiring  clerks  and  registers  of  equity  courts  to  report  all  divorces  to 
the  State  Board  of  Health. 

(j)  Increasing  the  appropriation  for  State  quarantine  purposes. 

A  bill  is  now  pending,  with  every  nrospect  of  becoming  a  law,  providing  for 
the  establishment  of  an  "Epileptic  Colony." 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  2O/ 

The  above  comprises  all  legislation  in  reference  to  public  health  matters 
enacted  within  the  past  two  years,  except  such  as  resulted  in  transferring  the 
maritime  quarantine  to  the  control  of  the  United  States  Public  Health  and 
Marine  Hospital  Service. 

REPORT  OF  DR.  SAMUEL  G.  DIXON,  COMMISSIONER  OF  HEALTH 
OF  THE  COMMONWEALTH  OF  PENNSYLVANIA,  DELEGATE 
FOR  THE  UNITED  STATES  OF  AMERICA. 

MR.  PRESIDENT  AND  GENTLEMEN: 

On  the  occasion  of  the  Second  International  Convention  of  the  American 
Republics  held  in  the  City  of  Washington,  in  October,  1905,  Dr.  John  S.  Fulton, 
Secretary  of  the  State  Board  of  Health  of  Maryland,  in  his  report  as  delegate 
for  the  United  States,  in  a  concise  and  admirable  statement  of  the  different 
modes  of  organization  for  sanitary  administration  prevailing  among  the  gov- 
ernmental units  under  our  system  mentioned  the  fact  that  Pennsylvania  had 
just  made  a  complete  change  in  her  plan  of  organization,  and  that  it  was  then 
too  early  to  judge  of  the  effects  of  the  change.  The  writer  is  fortunately 
in  a  position  not  only  to  present  to  the  Convention  the  details  of  the  new  system 
but  furnish  approximate  results  of  its  application  from  which  the  delegates  may 
be  able  to  determine  whether  the  move  was  not  a  wise  one. 

For  twenty  years  the  sanitary  affairs  of  the  State  had  been  administered 
by  a  Board  of  Health,  whose  members  resided  at  widely  scattered  points 
throughout  her  limits.  This  Board  elected  a  Secretary  who  was  its  Executive 
Officer  and  therefore  the  Chief  Sanitary  Officer  of  the  Commonwealth.  His 
powers  were  circumscribed,  and  in  addition  to  this,  the  pecuniary  means  appro- 
priated to  the  Board  by  the  legislature  were  extremely  limited.  Under  these 
circumstances  the  Board  confined  itself  to  a  considerable  extent  to  missionary 
work,  interfering  little  with  general  insanitary  conditions  except  in  case  of 
great  epidemics  or  unusual  catastrophes,  when  it  managed  to  obtain  a  larger 
appropriation  under  stress  of  fear.  The  change  that  was  made  consisted  in  the 
passage  of  an  entirely  new  law,  which  abrogated  the  old  Board  and  established 
in  its  place  a  Department  having  an  equal  standing  in  the  Government  with 
other  long-established  departments  such  as  that  of  State  or  of  the  Treasury. 
This  law,  with  x>ther  related  documents,  will  be  found  in  the  full  report  in  the 
appendix.  This  Department  consisted  of  two  factors,  the  Commissioner  of 
Health,  who  was  made  the  complete  repository  of  power,  and  an  Advisory 
Board  composed  of  six  physicians  of  high  attainment,  and  a  Civil  Engineer, 
which  the  Commissioner  would  call  upon  for  purposes  of  consultation  at  his 
convenience,  and  to  which  was  assigned  the  duty  of  drawing  up  general  regu- 
lations for  the  proper  performance  of  the  Department.  The  immense  advantage 
of  promptness  of  action  in  such  emergencies  as  are  constantly  occurring  in  the 
experience  of  health  officers,  instead  of  waiting  on  the  action  of  a  considerable 
body  of  widely  separated  individuals,  needs  no  demonstration.  A  greatly  in- 
creased appropriation  afforded  the  Commissioner  the  means  for  putting  into 
force  such  reforms  as  he  at  once  saw  to  be  necessary  in  order  to  place  the 
health  affairs  of  the  State  upon  at  least  as  high  a  plane  as  those  of  any  other 
State.  At  the  same  time  the  legislature  enacted  a  law  providing  for  the  imme- 
diate registration  of  births  and  deaths,  a  matter  shamefully  neglected  up  to 
that  time,  and  placed  this  system  under  the  general  supervision  of  the  Commis- 
sioner of  Health. 

Under  the  lax  legislation  for  the  prevention  of  the  pollution  ot  public  waters 
previously  prevailing,  all  of  the  streams  of  the  State,  most  of  which  were  uti- 
lized as  sources  of  drinking  water,  were  becoming  terribly  and  disgustingly 
contaminated.  The  new  legislation  placed  this  whole  matter  in  the  hands  of 
the  Commissioner  associated  in  his  final  decisions  with  the  Governor  and  the 
Attorney-General  of  the  State.  Thus  it  will  be  seen  that  in  this  one  official  was 
concentrated  all  the  internal  sanitary  authority  of  the  State.  The  authority 
in  external  affairs,  the  .administration  of  seaboard  quarantine,  was  still  left  in 
the  hands  of  the  State  Quarantine  Board  hereafter  to  be  described,  but  of  that 
Board  he  was  also  made  a  member. 

In  addition  to  the  general  grant  of  authority  "to  determine  the  most  efficient 
and  practical  means  for  the  prevention  and  suppression  of  disease"  the  follow- 
ing are  among  powers  specifically  accorded  him. 


2O8  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

To  determine  what  assistants  it  is  necessary  to  employ  and  to  make  all  ap- 
pointments. 

To  purchase  all  supplies  and  materials  necessary  for  carrying  on  the  work 
of  his  Department. 

To  issue  subpoenas  to  secure  the  attendance  of  witnesses  and  compel  them 
to  testify. 

To  issue  warrants  to  any  sheriff,  constable,  or  policeman  to  apprehend  and 
arrest  such  personas  as  disobey  the  quarantine  orders  or  regulations  of  the 
Department.  This  warrant  must  be  executed  forthwith  and  return  of  the  execu- 
tion must  be  duly  made  to  the  Comimssioner. 

To  either  personally  or  by  his  agents,  without  fee  or  hindrance,  enter,  examine 
and  survey  all  grounds,  vehicles,  apartments,  buildings  and  places  suspected  of 
containing  nuisances  affecting  the  security  of  life  and  health,  and  to  confer  the 
authority  of  constables  on  his  agents  for  such  purposes. 

To  order  nuisances  to  be  abated  and  removed  and  to  enforce  quarantine 
regulations. 

To  have  the  general  supervision  of  the  State  registration  of  births,  marriages, 
deaths  and  diseases;  of  practitioners  of  medicine  and  surgery,  of  midwives, 
nurses  and  undertakers. 

Any  violation  of  the  Department's  orders  issued  by  the  Commissioner  consti- 
tutes a  misdemeanor  and  is  punishable  by  fine  or  imprisonment  or  both.  Such 
were  the  powers  conferred. 

Let  us  consider  for  a  moment  the  task  which  confronted  the  new  Depart- 
ment. 

While  all  large  cities  and  boroughs  and  many  of  the  smaller  boroughs  (incor- 
porated villages)  already  possessed  Boards  of  Health  of  their  own,  few  of 
these  boards  were  maintaining  a  system  more  or  less  efficient  of  registration  of 
vital  statistics.  Moreover,  all  the  vast  rural  and  mountainous  regions  of  the 
State  were  without  Boards  of  Health  or  systems  of  registration,  not  even 
requiring  certificates  for  the  burial  of  the  dead;  so  that  a  human  being  could 
be  put  under  the  ground  with  as  little  legal  record  as  a  dog.  What  this  means 
will  be  understood  when  it  is  said  that  Pennsylvania  has  a  population  of  seven 
million  people  with  an  area  of  forty-five  thousand  square  miles  and  contains  30 
cities,  849  boroughs,  67  counties  and  1,547  townships — a  total  of  2,426  separate 
and  distinct  municipalities  which  must  be  considered  individually  in  all  public 
health  work.  The  total  population  estimated  for  1906  is  6,884,388,  of  which 
4,447,586  are  included  within  the  limits  of  incorporated  cities  and  boroughs, 
and  2,436,802  reside  in  rural  districts.  In  at  least  400  boroughs,  or  about  50 
per  cent,  either  no  Board  of  Health  heretofore  existed,  or  one  had  existed  in 
name  only.  In  1,547  townships  absolutely  no  permanent  health  organization  had 
been  provided  for,  so  that  at  the  date  of  the  creation  of  the  Department  of 
Health  at  least  one-half  of  the  people  in  our  State,  or  about  three  and  one-half 
millions,  were  without  any  permanent  local  protection  to  life  or  health.  To 
properly  safeguard  these  people  and  provide  for  their  protection  was  one  of  the 
first  efforts  of  the  Department  of  Health,  and  in  order  that  this  might  be  done 
more  effectually,  the  Department  keeps  in  close  touch  and  co-operates  with  all 
the  municipalities  which  have  Boards  of  Health  of  their  own. 

As  regards  the  pollution  of  streams  the  conditions  which  confronted  us  were 
almost  indescribable;  the  individual  householder  constructing  an  overhanging 
privy  and  polluting  the  small  stream  that  finds  its  way  past  his  property;  the 
small  town  defiling  with  raw  sewage  a  stream  of  water  that  is  expected  to 
quench  the  thirst  of  villagers  not  far  away;  the  large  municipalities  discharging 
the  contents  of  their  large  sewers  into  the  river  that  is  the  water  supply  for 
thousands  and  thousands  of  human  beings  further  down  the  stream.  As  tnis  has 
been  going  on  for  generations,  it  need  not  be  said  that  it  is  not  the  work  of  a 
day  or  a  year  to  stop  it;  but  stop  it  we  must,  and  in  this  great  work  already 
public  sentiment  is  coming  to  our  aid.  The  people  are  beginning  to  appreciate, 
however,  that  a  sanitary  method  of  sewage  disposal  is  not  costly  compared  with 
the  money  outlay  that  typhoid  fever  demands  in  our  State  every  year,  not  to 
speak  of  the  awful  harvest  of  misery,  suffering,  and  death  that  it  reaps. 

The  laws  for  the  suppression  of  contagious  diseases  were  very  imperfectly 
enforced  and  smallpox,  diphtheria  and  scarlet  fever  and  other  communicable 
diseases  were  lamentably  rife,  and  the  central  authority  was  without  means  of 
obtaining  early  information  of  the  existence  of  such  affections,  so  that  steps 
might  be  taken  to  prevent  epidemics. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  2OQ 

No  provision  existed  by  which  the  modern  facilities  for  the  bacterial  diagnosis 
of  disease  could  be  extended  to  physicians  outside  of  the  large  cities. 

The  State  was  taking  no  commensurate  part  in  the  great  campaign  being 
waged  against  the  great  enemy  of  the  human  race,  tuberculosis. 

All  of  these  conditions  demanded  immediate  attention.  In  order  to  establish 
such  a  registration  system  as  the  law  contemplated  it  was  necessary  to  select 
men  throughout  the  State  of  sufficient  education  and  standing  to  collect  these 
statistics.  Such  officials  under  the  title  of  Local  Registrars  are  now1  established 
in  every  nook  and  corner  of  the  State  to  the  number  of  972,  each  with  a  deputy, 
and  in  addition,  214  sub-registrars.  Within  six  months  from  the  establishment 
of  the  Department  the  system  was  ready  to  be  inaugurated,  and  before  the  year 
had  half  elapsed  showed  such  complete  and  accurate  results  that  the  Census 
Bureau  of  the  National  .Government  did  not  hesitate  to  admit  Pennsylvania  to 
the  number  of  registration  States. 

In  making  this  announcement  the  Director  of  the  Census  said:  "I  cordially 
congratulate  you  upon  the  great  work  you  have  done  in  organizing  the  regis- 
tration system  of  Pennsylvania,  and  I  am  highly  gratified  that  it  is  possible  at 
this  early  date  to  increase  the  registration  area  by  the  addition  of  so  important 
a  commonwealth." 

When  it  is  considered  that  Pennsylvania  has  never  heretofore  been  recognized 
in  the  United  States  Census  reports  and  that  during  the  period  of  thirty  years 
covered  by  these  reports  that  but  ten  States  have  been  so  recognized,  the  result 
achieved  in  the  initial  year  of  our  work  in  this  respect  may  be  considered  as 
witnessing  to  the  efficiency  of  our  system  which  it  may  be  said  is  in  closest 
harmony  with  that  of  the  Federal  Government. 

In  the  year  1906  the  number  of  births  reported  was  172,000.  The  number  of 
deaths  was  123,195.  These  have  been  registered,  indexed,  filed  and  bound  for 
reference. 

In  order  to  supply  the  lack  of  sanitary  authorities  in  the  townships  or  rural 
communities,  in  addition  to  urging  the  smaller  municipalities  to  accept  their 
legal  duty  of  establishing  Boards  of  Health,  750  Health  Officers  have  been 
appointed.  These  men  are  responsible  solely  to  the  State  Commissioner  of 
Health.  In  this  way  has  been  organized  a  State  Sanitary  constabulary  which, 
having  no  favors  to  ask  from  the  people  or  the  local  authorities,  will  be  loyal 
to  the  State  and  will  not  hesitate  to  do  its  full  duty. 

I  would  like  to  refer  briefly  to  their  part  in  controlling  the  spread  of  com- 
municable disease.  These  township  Health  Officers  in  each  county  work  under 
the  supervision  of  our  County  Medical  Inspector,  who  personally  investigates 
all  epidemics  in  the  rural  districts  and  also  in  the  boroughs  and  cities  when 
conditions  in  these  municipalities  get  beyond  the  control  of  the  local  health 
boards. 

The  physicians  of  the  State,  and  we  have,  I  believe,  about  eleven  thousand  in 
Pennsylvania,  report  each  case  of  communicable  disease  occurring  in  their  prac- 
tice in  the  townships  to  our  Department's  health  officer  in  that  township,  'imme- 
diately upon  the  receipt  of  this  notice  the  health  officer  placards  the  premises, 
establishes  the  necessary  quarantine,  furnishes  the  householder  with  a  Depart- 
ment circular  setting  forth  the  rules  to  observe  to  control  the  spread  of  the 
disease  and  gives  the  proper  notice  of  the  case  to  the  school  authorities  and  to 
the  local  public  library.  By  reason  of  the  fact  that  the  State  is  so  completely 
covered  by  our  health  officers,  the  least  time  possible  elapses  between  the 
report  of  the  case  by  the  physician  and  the  inauguration  of  the  Department's 
precautionary  measures,  and  I  cannot  refrain  right  here  from  acknowledging 
the  support  which  the  medical  practitioners  of  Pennsylvania  are  giving  the 
Department  by  the  prompt  reporting  of  cases,  making  it  seldom  necessary  for 
us  to  ask  the  Court  to  compel  the  enforcement  of  the  law.  Upon  notice  of  the 
physician  or  County  Medical  Inspector  the  health  officer  removes  placards, 
raises  quarantine  and  thoroughly  disinfects  the  premises  in  the  manner  described 
in  the  Health  Officers'  Manual. 

The  township  health  officer  re-mails  daily  to  the  central  office  of  the  State 
Department  of  Health  the  physician's  report  of  every  case  of  communicable 
disease.  In  cities  and  boroughs  such  cases  are  reported  by  the  physician  to  the 
Secretary  of  the  local  Board  of  Health,  who  in  return  sends  a  weekly  report 
to  the  State  .Department  of  Health.  Thus  the  Commissioner  is  in  the  closest 
possible  touch  with  the  health  conditions  prevailing  in  every  community  through- 
out the  State.  It  was  through  these  reports  of  communicable  disease  that  the 


2IO  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

new  Department,  shortly  after  its  inauguration,  discovered  that  diphtheria  was 
prevalent  to  an  extent  heretofore  unsuspected  throughout  the  State.  The  pos- 
sibility of  lessening  the  alarming  mortality  from  this  disease  so  destructive  to 
child  life,  by  the  use  of  antitoxic  serum,  naturally  suggested  itself  and  we  there- 
fore established  depots  for  the  free  distribution  of  that  agent  to  the  poor  through 
their  physicians.  For  this  purpose  there  are  over  500  distributing  centers,  of 
which  the  following  is  the  record  to  March  I,  1907: 

Date  of  inauguration November  4, 1905. 

Present  number  of  stations  511 

Number  of  cases  treated  4,635 

Number  of  deaths 445 

Percentage 9  6/10 

Number  immunized 2,813 

Number  contracting  the  disease  after  being  immu- 
nized, all  of  whom  recovered  . .' 73 

Number  of  packages  of  1,000  units  dispensed  up  to 

the  present  time   4,317 

Number  of  packages  of  3,000  units  dispensed  up  to 

the  present  time   7,936 

As  the  number  of  these  cases  which  would  have  been  able  to  procure  the 
antitoxin  treatment,  but  for  the  wise  intervention  of  the  State,  would  have  been 
very  small,  it  is  only  fair  to  compare  the  results  obtained  with  those  which 
prevailed  before  the  introduction  of  antitoxin. 

Allowing  40  per  cent  as  the  mortality  rate,  that  being  the  rate  in  New  York 
in  1892,  there  should  have  been  1,854  deaths  among  the  4,635  cases  treated.  The 
actual  number  was  445,  or  9-6/10  per  cent.  Hence  there  was  a  direct  saving 
of  1,409  lives  in  the  brief  space  of  sixteen  months. 

This  successful  result  was  in  part  due  to  the  fact  that  no  region  in  the  State, 
however  remote,  was  left  without  a  convenient  distributing  center,  and  in  this 
way  an  opportunity  for  the  early  administration  of  the  remedy  was  afforded ; 
and  secondly,  that  with  each  package  was  contained  a  memorandum  for  the 
physician  urging  the  importance  of  extreme  promptness  in  its  employment  and 
in  large  doses. 

In  the  matter  of  the  purification  of  streams  and  water  supplies  the  law  forbids 
the  introduction  of  any  new  system  of  water  supply  or  sewerage  or  the  exten- 
sion of  any  present  system  without  a  permit  from  the  Commissioner  of  Health. 
It  also  requires  plans  of  all  such  systems  to  be  filed  in  the  Department  of 
Health.  It  will  readily  be  understood  that  this  provision  requires  a  large  engi- 
neering corps  both  for  office  and  for  field  work.  Working  in  harmony  with 
the  Department  of  Medical  Inspection  much  work  has  been  done  in  this  division 
in  the  suppression  of  epidemics  of  typhoid  fever. 

In  the  neighborhood  of  two  hundred  applications  for  approval  of  plans  of 
water  works  and  sewers  have  been  considered,  and  permits  have  been  issued 
for  the  installation  of  new  works,  for  the  extension  of  old  works  and  for  the 
obtaining  of  new  supplies  of  water  under  such  conditions  and  stipulations  as 
shall  assure  the  construction  of  proper  works  in  the  first  instance  and  the 
efficient  operation  and  maintenance  of  them  thereafter. 

It  is  useless  to  require  corporations  either  public  or  private  to  assume  large 
expenditures  for  the  erection  of  works  to  purify  sewage  and  not  also  maintain 
supervision  over  the  operation,  because  experience  the  world  over  has  proven, 
in  such  matters,  that  the  local  officers  either  become  negligent  or  purposely,  in 
order  to  avoid  expense,  resort  to  lax  methods  of  operation.  This  has  been 
peculiarly  the  fact  relative  to  municipal  works.  The  public  policy  which  admits 
State  approval  of  the  plans  also  dictates  that  State  supervision  of  the  operation 
shall  obtain. 

Still  further  as  a  protective  measure,  it  has  been  necessary,  in  answer  to 
numerous  petitions  and  complaints,  to  place  in  the  field  some  two  score  of 
special  inspectors,  in  addition  to  our  township  health  officers,  to  investigate  all 
occupied  estates  on  rural  water  sheds  of  average  size,  and  to  bring  about  a  proper 
disposal  of  sewage  and  waste  matters  on  such  estates.  All  told,  in  the  neigh- 
borhood of  ten  thousand  properties  have  been  thus  inspected  and  abatements 
effected  wherever  menaces  to  health  existed. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  211 

So  much  for  the  plan  of  organization  of  the  Department  which  now  has  nearly 
3,000  men  on  its  working  staff.  The  keynote  of  this  organization  is  centraliza- 
tion of  authority,  avoiding  divided  counsels  and  insuring  promptness  and  effi- 
ciency of  action,  essential  factors  in  a  successful  administration. 

Probably  no  better  test  as  to  its  success  can  be  adduced  than  the  action  of 
the  last  biennial  session  of  the  State  legislature. 

That  body  set  the  seal  of  its  approbation  upon  the  work  already  accomplished 
by  the  new  Department  by  increasing  its  appropriation  from  the  already  unheard- 
of  sum  of  $300,000  to  $1,000,000  for  its  routine  work,  and  an  additional  $1,000,- 
ooo  for  the  campaign  against  tuberculosis.  Of  this  latter  amount  $600,000  is 
to  be  devoted  to  the  founding  in  the  Forest  Reservations  of  the  State  of  sana- 
toria for  the  consumptive  poor,  and  $400,000  to  the  establishment  of  dispensaries 
for  the  same  class  of  sufferers. 

The  scheme  for  the  sanatoria  which  we  have  adopted  in  Pennsylvania  is  a 
comprehensive  one.  We  are  utilizing  the  great  forest  reservations  of  the  State 
for  the  purpose  of  hospital  or  sanatorium  treatment.  It  is  proposed  to  have 
two  colonies  at  widely  separate  points  that  they  may  be  accessible  from  differ- 
ent parts  of  the  State.  One  of  these  has  already  been  started  and  is  caring 
for  a  large  number  of  patients.  Instead  of  massive  structures  of  brick  or 
stone  we  are  erecting  a  large  number  of  frame  cottages,  each  of  which  will 
accommodate  eight  patients.  These  cottages  of  four  rooms  each  are  being 
situated  in  relation  to  the  points  of  the  compass  so  as  to  secure  the  maximum 
amount  of  sunlight  during  every  day  of  the  year.  There  are  no  porches  to  keep 
out  the  sun's  rays  from  the  rooms  of  the  cottages.  Instead,  we  are  building 
an  adequate  number  of  sun  pavilions. 

Somewhat  apart  from  these  there  will  be  an  infirmary  for  those  in  the  more 
advanced  stages  of  the  disease.  In  this  building  those  to  whom  we  cannot 
hold  out  hopes  of  recovery  will  be  afforded  shelter  and  the  comforts  of  a  home 
in  the  closing  days  of  life ;  and  the  extension  of  relief  to  these  helpless  sufferers 
will  be  more  than  justified  in  the  fact  that  we  are  removing  them  from  their 
confined,  crowded,  ill-ventilated  and  impoverished  homes  at  the  time  when 
they  would  be  most  in  danger  of  communicating  the  disease  to  other  members 
of  the  family  and  the  greatest  menace  to  the  public. 

After  recovery  the  male  patients  will  be  afforded  opportunities  for  work  in 
forestry  for  which  they  will  be  entitled  to  their  board  and  clothing,  for  a 
sufficient  time  to  test  their  strength  and  the  reality  of  the  cure.  Men  whose 
previous  occupations  have  been  such  as  to  create  a  great  deal  of  dust,  such 
as  saw  sharpeners  and  stone  cutters,  will  be  urged  to  seek  permanent  work  of 
a  less  objectionable  nature.  And  those  of  both  sexes  will  be  counselled  to  as 
far  as  possible  find  opportunities  for  work  in  the  country,  and  the  force  of  the 
Department  scattered  over  the  entire  State  will  be  used  to  help  to  find  healthful 
employment  for  those  who  have  recovered  sufficiently  to  be  dismissed  from 
the  care  of  the  State. 

We  are  establishing  also,  in  each  of  sixty-seven  counties  of  the  State,  a  Dis- 
pensary for  tuberculosis  under  the  direct  supervision  of  the  Department.  The 
object  of  these  dispensaries  is  two-fold.  First,  many  cases  unable  to  leave  their 
homes  for  a  prolonged  stay  in  a  sanatorium  come  here  frequently  for  advice 
in  regard  to  matters  of  diet,  medication  when  needed,  and  the  open  air  treat- 
ment as  far  as  this  is^possible  at  home.  Secondly,  they  receive  careful  instruc- 
tion in  all  the  precautions  necessary  to  be  observed  for  the  protection  of  others. 
Their  compliance  with  these  instructions  is  an  essential  to  their  continuing  to 
receive  State  treatment,  In  fact  "the  dissemination  of  knowledge  relating  to 
the  prevention  and  cure  of  tuberculosis  and  for  the  study  of  social  and  occu- 
pational conditions  that  predispose  to  its  development"  is  expressly  noted  in 
the  act  creating  the  system  as  one  of  its  important  objects. 

The  Sanatoria  and  Dispensaries  are  being  pushed  to  completion  as  rapidly  as 
possible,  and  are  destined  not  only  to  prove  a  bulwark  against  the  spread  of  that 
devastating  plague,  but  an  opportunity  for  scientific  investigation  which  may  lead 
to  its  entire  extermination. 

For  this  latter  purpose  the  magnificent  laboratories  placed  at  the  disposal  of 
the  Department  by  the  University  of  Pennsylvania  in  the  City  of  Philadelphia 
will  be  made  use  of,  and  the  experiments  already  so  successfully  conducted  on 
the  subject  of  immunity  against  tuberculosis  in  the  inferior  animal  will  be 
prosecuted  with  increased  vigor  in  the  confident  hope  that  success  in  this  direc- 
tion may  also  be  attained  in  the  human  being. 


212  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

In  connection  with  this  brief  statement  as  to  the  methods  which  we  propose 
to  adopt  in  our  own  State  for  banishing  this  plague  it  will  be  appropriate  here 
to  introduce  as  requested  a  suggestion  of  practical  means  to  prevent  persons 
suffering  from  tuberculosis  from  transmitting  the  disease  to  the  healthy  persons 
who  may  be  travelling  in  their  company  either  in  trains  or  vessels. 

In  order  to  accomplish  this  object  satisfactorily  it  would  be  necessary  for 
transportation  companies  to  furnish  separate  apartments  for  those  suffering 
from  that  disease  and  either  to  furnish  them  with  wooden  dishes  and  eating 
utensils  which  could  at  once  be  burned,  or  submit  all  eating  utensils  to  boiling 
or  high  steam  pressure.  Neither  of  these  suggestions  are  practicable  at  the 
present  time  at  least. 

We  must  consider  such  persons  as  travelling  in  the  ordinary  day  coach  or 
sleeping  car  and  taking  their  meals  in  either  dining  cars,  buffet  cars  or  station 
restaurants. 

Practically  the  same  conditions  would  obtain  when  travelling  by  water. 

The  first  essential  is  that  the  clothing  and  contents  of  the  pockets,  including, 
of  course,  the  tickets  and  checks,  be  kept  free  from  contamination.  To  this  end 
the  patients  should  carry  sputum  cups  and  should  expectorate  only  in  them — 
not  in  their  pocket  handkerchiefs.  The  secretions  of  the  nose  should  be  received 
on  small  pieces  of  cheap  fabric  to  be  used  only  once.  These  should  be  placed 
at  once  in  a  rubber  lined  bag  and  be  burned  as  often  as  opportunity  occurs. 

Such  persons  should  never  place  their  money  or  their  tickets  in  their  mouths. 

They  should  not  smoke  pipes  or  use  cigar  holders.  Cigar  or  cigarette  stumps 
should  be  placed  in  the  rubber  lined  bags  with  the  discarded  nasal  cloths. 
They  should  carry  their  own  soap  and  should  never  rinse  their  mouths  or 
brush  their  teeth  in  the  basin  of  the  lavatory.  They  should  use  only  their  own 
hair  brushes  and  combs  and  after  washing  should  see  that  the  basin  they  have 
used  is  thoroughly  scalded. 

Men  should  keep  their  lips  and  chins  closely  shaven.  Patients  should  not 
permit  their  clothing  to  be  brushed  except  in  the  open  air. 

In  conclusion,  Mr.  President  and  fellow  delegates,  since,  as  one  of  the  Unite.d 
States'  representatives,  I  have  been  honored  with  the  opportunity  of  telling  you 
what  my  own  Commonwealth  of  Pennsylvania  is  doing  in  the  battle  against 
disease,  I  pledge  you  for  that  State  and  her  sister  States,  hearty  co-operation  in 
every  movement  that  aims  toward  the  betterment  of  health  conditions  on  our 
two  great  Western  Continents. 

We  are  all  working  toward  the  same  goal.  Ours  is  a  glorious  mission;  to 
war  against  diseases  that  are  preventable;  to  educate  the  great  masses,  so  that 
they  themselves  shall  become  vigorous  recruits  in  the  ranks  of  the  Sanitarian; 
to  relieve  misery  and  suffering;  to  help  our  fellow  man. 

What  greater  ambition  could  we  have! 

REPORT  ON  THE  QUARANTINE  IN  NEW  YORK,  PRESENTED  BY 
DR.  A.  H.  DOTY,  HEALTH  OFFICER  OF  THE  PORT  OF  NEW 
YORK  AND  DELEGATE  FROM  THE  UNITED  STATES. 

The  Quarantine  Establishment  at  the  port  of  New  York  has  from  time  to 
time  been  enlarged  and  its  equipment  improved  to  comply  with  modern  sanita- 
tion. At  present  it  consists  of  the  following : 

An  administration  and  boarding  station,  situated  on  the  Staten  Island  coast 
at  the  entrance  of  the  New  York  Bay,  about  seven  miles  from  the  city  of  New 
York.  This  station  consists  of  the  administration  building,  laboratory,  residences 
of  medical  officers,  etc.,  and  docks  and  boats  used  in  the  Quarantine  Service. 
There  are  four  steam  vessels  for  this  purpose,  one  of  which  is  a  portable  dis- 
infecting plant. 

At  this  station  are  inspected  all  incoming  foreign  vessels,  and  at  certain  seasons 
of  the  year  some  domestic  ones. 

Transfers  of  patients  and  persons  held  for  observation  take  place  at  this 
station. 

In  the  Lower  Bay,  about  two  and  three  miles  respectively  from  the  boarding 
station,  and  over  a  mile  from  the  mainland  are  two  islands  constructed  on  a 
sand  bar  for  quarantine  purposes.  The  upper  one  comprising  about  thirteen  acres 
is  known  as  Hoffman  Island.  This  island  is  for  the  detention  of  persons  who 
have  presumably  been  exposed  to  infectious  diseases.  The  buildings  consist 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  213 

of  large  dormitories  situated  at  the  upper  end  of  the  island  for  the  reception 
of  third,  or  steerage  passengers,  and  second  cabin  passengers,  and  at  the  lower 
end  of  the  island  are  buildings  for  the  accommodation  of  saloon  or  first  cabin 
passengers.  Over  2,000  persons  can  be  cared  for  at  this  place.  This  island  also 
contains  a  large  disinfecting  plant,  consisting  of  three  modern  steam  chambers, 
20  feet  long  by  5  feet  in  diameter,  one  of  which  has  been  so  constructed  that  it 
may  be  used  for  formaldehyde  disinfection. 

Swinburne  Island  is  about  one  mile  below  Hoffman  Island  and  is  much  smaller 
in  area  and  is  for  the  care  and  treatment  of  infectious  disease.  This  island  is 
being  practically  rebuillt.  Six  new  brick  and  cement  one-story  hospital  pavilions, 
with  every  modern  equipment  and  with  accommodation  for  over  one  hundred 
patients  are  in  process  of  construction,  and  are  substituted  for  the  wooden 
hospital  buildings  which  previously  existed.  Both  islands  have  a  corps  of  assist- 
ants and  every  provision  is  made  for  any  emergency. 

The  yearly  work  of  the  Department  may  be  illustrated  by  extracts  from  the 
report  of  1906,  which  are  as  follows  : 

Number  of  foreign   vessels   inspected 4493 

Number  of  domestic  vessels  inspected 1,654 

Number  of  persons  inspected  on  incoming  vessels 1,033,962 

Number  of  persons  held  for  detention 4,570 

Number  of  cases  of  disease  removed 134 

Number  of  steam  disinfections   232 

Number  of  formaldehyde  and  sulphur  dioxide  disinfections 1,041 

In  connection  with  the  regular  work  of  this  Department,  considerable  investi- 
gation has  been  made  in  regard  to  the  mosquito  and  its  extermination.  This 
investigation  has  been  continued  over  a  period  of  six  years,  and  among  other  in- 
teresting results  obtained  it  has  been  shown  that  seventy-five  or  eighty  per  cent 
of  the  mosquitoes  which  are  found  along  the  the  Atlantic  coast,  and  in  and 
about  New  York  consists  of  the  "culex  sollicitans,"  "strip-legged,"  or  "Atlan- 
tic" coast  mosquito,  and  that  this  variety  does  not  breed  inland  but  only  in  salt 
water  marshes  along  the  coast,  and  that  the  only  means  of  exterminating  this 
variety  is  the  proper  draining  of  the  said  land. 

An  appropriation  was  made  by  the  City  of  New  York  in  October,  1905,  for 
the  purpose  of  draining  the  salt  swampy  land  along  the  coast  of  Staten  Island 
which  is  one  of  the  boroughs  of  New  York  City,  and  the  work  was  begun  in  the 
following  month,  November,  1905,  and  is  now  nearing  completion.  Already 
over  400  miles  of  ditches  have  been  dug,  and  about  20  square  miles  of  swamp 
land  have  been  drained.  The  ditches  are  about  ten  inches  wide  and  about  two 
feet  deep,  and  from  50  to  250  feet  or  more  apart,  depending  on  the  character  of 
the  land.  These  ditches  empty  into  the  sea  at  different  parts  of  the  coast. 

The  results  have  been  eminently  successful  and  in  sections  where  the  drainage 
has  been  completed,  the  mosquito  has  practically  disappeared.  The  breeding1 
places  which  cover  vast  areas  can  only  be  successfully  dealt  with  by  federal 
state  or  municipal  control  as  individual  work  would  manifestly  be  of  no  value. 
Some  photographs  of  this  work  accompany  this  report  and  will  show  the  swamp 
land  above  referred  to  before  and  after  drainage. 

REMARKS  OF  H.  L.  E.  JOHNSON,  M.D.,  WASHINGTON,  D.  C,  A  DELE- 
GATE FROM  THE  UNITED  STATES. 

The  Port  of  Washington,  D.  C.,  is  situated  on  and  between  the  Potomac  River, 
and  its  -Eastern  Branch,  the  Anacostia,  no  miles  from  its  mouth,  the  Chesapeake 
Bay.  It  is  a  tide  water  river,  fresh  at  Washington,  brackish  and  salt,  30  miles 
below.  For  many  years  malaria  (Anopheles)  fever  has  been  prevalent  in  con- 
sequence of  the  extensive  mosquito-breeding  flats  and  marsh  lands  along  and 
within  the  water  courses,  which  are  largely  bare  at  low  tide,  abundant  in  rank 
vegetation  and  upon  which  sewage  is  alternately  deposited  and  exposed  with 
each  tide.  To  correct  these '  insanitary  conditions  and  increase  the  harbor 
capacity,  extensive  engineering  work  has  been,  and  is,  in  progress.  Heavy  sea 
walls  are  being  constructed,  navigation  and  water  currents  improved  by  dredg- 
ing the  channels  to  a  depth  of  24  feet  at  low  tide,  flats  and  swamp  lands  are 
being  filled  up,  drained,  raised  many  feet  above  the  high  water  mark,  and  con- 
verted into  public  parks.  Strict  police  health  regulations  have  been  adopted, 


214  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

prohibiting  contamination  of  the  water  courses,   from  ship  or  shore,  by  the 
introduction  of  vegetable  waste,  dead  animals,  or  other  refuse  matter. 

SEWER    SYSTEM. 

A  new  system  of  sewers  has  been  projected  which  will  free  the  harbor  from 
sewage  contamination.  This  system  of  sewage  disposal  is  based  upon  the  dis- 
charge of  sewage  from  a  population  of  500,000,  and  consists  of  a  pumping 
station  connected  with  trunk  and  section  sewers,  which  is  finally  to  discharge 
about  three  miles  below  the  harbor  at  the  bottom  of  the  Potomac  River  where 
the  flow  and  volume  of  water  are  sufficient  to  dilute  all  such  sewage  discharge 
and  render  it  inoffensive.  The  problem  of  disposal  of  surface  or  drainage  water, 
and  the  construction  of  suburban  sewers  to  meet  the  demands  of  growing 
outlying  settlements  is  being  estimated  and  provided  for  by  the  U.  S.  Engineers, 
within  the  annual  appropriations  -by  Congress.  Eventually  every  building  in 
the  District  of  Columbia  will  have  sewel-  and  water  connection. 

PUBLIC   CONVENIENCE    STATIONS    AND    PUBLIC   BATHS. 

Two  public  convenience  stations  of  modern  design  and  construction  have 
been  completed  in  the  business  section  of  the  city  and  a  public  bath,  with 
floating  and  stationary  bath  houses  is  being  perfected  on  the  river  front. 

WATER  SUPPLY  AND  FILTRATION 

The  water  supply  is  obtained  from  the  Potomac  River  at  the  Great  Falls, 
about  18  miles  above  the  port,  and  was  formerly  clarified  by  sedimentation  only. 
Since  October,  1905,  the  filtration  plant,  of  the  slow  sand  type,  which  many 
of  you  inspected  when  attending  the  second  International  Sanitary  Convention, 
has  been  completed  and  is  supplying  the  entire  system  with  clean  "and  healthful 
water. 

SHALLOW    WELLS. 

Shallow  wells  for  potable  water  are  kept  under  careful  observation  and  when 
found  contaminated,  are  condemned  by  the  authorities  and  destroyed.  Many 
have  recently  been  condemned  and  destroyed  and  it  will  not  be  a  great  while 
before  shallow  wells  in  Washington  will  be  a  relic  of  the  past. 

INSANITARY  BUILDINGS  AND  BACK  YARDS. 

The  Act  of  May  7,  1906,  provides  for  the  enforcement  of  sanitation  of  build- 
ings, when  necessary,  evacuation  or  demolition,  after  condemnation  by  a  board 
created  for  that  purpose.  Criminal  prosecution  is  provided  for  failure  to  com- 
ply with  the  provisions  of  the  statute.  Many  shacks  and  other  buildings  coming 
within  the  scope  of  the  law  have  been  condemned  and  demolished,  though  in 
many  cases  the  insanitary  conditions  have  been  removed  by  the  occupants  or 
owners,  thus  relieving  the  application  of  drastic  measures.  The  Commissioners 
of  the  District  have  promulgated  a  regulation  supplemental  to  the  above,  re- 
quiring all  basements,  cellars,  back  yards  and  private  alleys  to  be  kept  clean, 
dry  and  free  from  filth  accumulation.  Inspections  are  made,  and  violations 
punished  by  fine. 

CONTAGIOUS  DISEASES  REPORTED. 

By  amendment  to  the  law  requiring  the  reporting  of  contagious  diseases  to 
the  Health  Office,  chickenpox,  measles,  whooping  cough,  typhoid  fever  and  epi- 
demic cerebro-spinal  meningitis,  are  now  included  in  that  class. 

INSPECTION   OF   DISTRICT   GOVERNMENT    BUILDINGS    AND   EMPLOYEES. 

The  Commissioners  have  promulgated  a  regulation  directing  the  Health  Officer 
to  inspect,  at  regular  intervals,  all  District  Government  buildings  for  the  pur- 
pose of  removing  all  sources' of  tubercular  infection,  if  existing,  and  to  inspect 
and  control  all  employees  infected  with  tuberculosis.  Anti-spitting  cards  are 
prominently  posted. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION. 
INSPECTION   OF   U.    S.   PUBLIC  BUILDINGS. 

The  President  has  appointed  a  special  commission  to  inspect  all  U.  S.  build- 
ings and  make  regulations  controlling  tuberculous  cases  and  insanitary  condi- 
tions. The  Commission  consists  of  the  Surgeons  General  of  the  Army,  Navy 
and  U.  S.  Public  Health  and  Marine  Hospital  Service. 

Amendments  to  an  ordinance  to  prevent  the  sale  of  unwholesome  food  and 
regulate  the  sale  of  drugs  in  the  cities  of  Washington  and  Georgetown,  were 
approved  by  the  Commissioners,  in  1907. 

Every  manager  of  a  store,  market,  cafe,  lunch-room,  or  any  other  place  where 
a  food  or  a  beverage  is  manufactured  or  prepared  for  sale,  stored  for  sale,  or 
sold,  which  store,  cafe,  lunch-room,  or  other  place  is  in  operation  at  the  time 
of  the  promulgation  of  this  regulation,  shall,  on  or  before  July  I,  1907,  register 
his  full  name,  and  the  location  of  said  store,  market,  cafe,  lunch-room,  or  other 
place,  and  the  nature  of  the  business  transacted,  in  a  book  to  be  kept  in  the 
Health  Office  for  that  purpose;  and  every  manager  of  a  store,  market,  cafe, 
lunch-room,  or  other  place  where  a  food  or  beverage  is  manufactured,  or  pre- 
pared for  sale,  stored  for  sale,  offered  for  sale,  or  sold,  that  is  first  opened  for 
business  after  the  promulgation  of  this  regulation  shall,  within  five  days  after 
the  opening  of  said  store,  market,  cafe,  lunch-room,  or  other  place,  register  in 
like  manner.  In  the  event  of  a  change  in  the  management  or  in  the  location  of 
any  store,  market,  cafe,  lunch-room,  or  other  place  aforesaid,  the  manager  there- 
of shall  call  at  the  Health  Office  within  five  days  after  such  change  takes  place 
and  make  a  corresponding  entry.  Any  person  who  violates  the  provisions  of  this 
regulation  shall,  upon  conviction  thereof,  be  punished  by  a  fine  not  exceeding 
twenty-five  dollars  for  each  and  every  such  offence. 

No  person  shall  expose  for  sale,  on  any  public  highway  or  in  any  open  market, 
stand  or  stall  in  the  District  of  Columbia,  candy,  cake,  or  bread,  dates  or  figs, 
or  any  other  food  of  a  kind  not  ordinarily  cooked,  peeled,  or  washed  before 
being  eaten,  unless  such  candy,  cake,  bread,  dates,  figs  or  other  article  of  food 
is  effectually  wrapped,  or  covered  and  enclosed,  so  as  to  protect  it  from  dust 
and  insects. 

No  person  selling  candy,  cake,  bread,  dates,  figs,  butter,  or  other  article  of 
food  of  a  kind  not  ordinarily  cooked,  peeled  or  washed  before  being  eaten,  shall 
wrap  or  cover  the  same  with  newspaper  or  with  any  other  paper  previously  used 
for  any  other  purpose. 

No  person  shall  expose  any  article  of  food  for  sale,  on  any  public  highway 
in  the  District  of  Columbia,  within  twenty-four  inches  from  the  surface  of  the 
ground,  unless  said  article  of  food  is  covered  or  so  closed  as  to  prevent  access 
of  dogs,  or  is  constantly  in  the  immediate  presence  of  the  owner  of  such  article 
of  food  or  the  proper  representative  of  such  owner  having  custody  thereof. 

No  vendor  or  distributor  of  foods  or  beverages  for  immediate  consumption 
on  or  about  the  place  of  business  of  such  vendor  or  distributor  shall  permit  any 
cup,  glass,  spoon,  or  fork  that  has  been  used  for,  or  in  connection  with  the 
consumption  of  any  such  food  or  beverage,  to  be  used  again  for  the  same  pur- 
pose until  after  it  has  been  thoroughly  washed  in  clean  water.  Any  person 
violating  any  of  these  provisions  shall  be  punished  by  a  fine  of  not  less  than 
one  dollar,  or  more  than  twenty-five  dollars,  for  every  violation. 

Every  manager  of  a  store,  market,  dairy,  cafe,  lunch-room  or  of  any  other 
place  in  the  District  where  a  food  or  a  beverage  or  confectionery,  or  any  similar 
article  is  manufactured  or  prepared  for  sale,  stored  for  sale,  offered  for  sale, 
or  sold,  shall  cause  it  to  be  screened  effectually  so  as  to  prevent  flies  and 
other  insects  from  obtaining  access  to  such  food,  etc.,  and  keep  it  free  from 
flies  and  other  insects  at  all  times.  Any  person  violating  the  provisions  of  this 
regulation  shall  upon  conviction,  be  fined  not  more  than  twenty-five  dollars 
for  each  and  every  such  offence. 

He  shall  equip  such  store,  etc.,  with  running  water  or  other  proper  water 
supply,  if  running  water  be  not  available,  and  with  facilities  and  material  for 
the  proper  washing,  and  shall  cause  such  washing  to  be  done  of  the  hands  of  all 
persons  employed  therein,  and  for  the  proper  cleaning  of  said  store,  etc.,  and  of 
utensils,  apparatus  and  materials  used  in  connection  therewith.  Persons  violating 
the  provisions  of  this  regulation  shall,  upon  conviction  .thereof,  be  punished  by  a 
fine  of  not  more  than  $25  for  each  and  every  such  offence. 


2l6  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

SUGGESTIONS    FOR  THE   PREVENTION    OF   THE   TRANSMISSION    OF   TUBERCULOSIS   TO 
HEALTHY  PERSONS  TRAVELING  ON  TRAINS,  SHIPS  OR  ELSEWHERE. 

Tuberculous  subjects  should  not  be  employed  on  cars  or  ships  in  any  capacity 
which  brings  them  in  direct  contact  with  persons  not  so  affected,  nor  should 
they  be  permitted  to  handle  or  come  in  contact  with  the  food,  water,  or  beverage 
supply 

No  person  so  affected  should  be  employed  as  porter,  or  in  any  capacity  in  a 
dining  car,  ship,  saloon  or  kitchen.  Tuberculous  patients  and  the  general  public 
should  be  minutely  instructed  concerning  the  cause,  transmission,  early  symp- 
toms, disinfection  of  sputum,  danger  of  contact  either  through  drinking  and 
eating  utensils,  or  otherwise,  and  the  absolute  necessity  of  co-operation  in  en- 
forcing the  recognized  hygienic  methods  for  preventing  the  spread  of  the  disease. 

Transportation  companies  should  be  required  to  furnish  separate  cars,  sec- 
tions, or  other  isolated  spaces  for  persons  known  to  be  tuberculous.  Par- 
ticularly is  this  precaution  essentially  on  the  lines  which  convey  tuberculous 
persons  to  the  various  "cure  localities"  and  continuing  onward  as  through  lines, 
sell  to  new  passengers  without  the  slightest  disinfection,  the  state  rooms  or  berths 
vacated  by  the  infected  passengers.  Specific  instances  of  this  neglect,  have  re- 
peatedly come  under  my  personal  observation. 

Disinfection  should  be  absolute  as  to  cars,  ships,  eating  and  drinking  utensils, 
napkins,  bedding,  towels,  carpets,  draperies,  cuspidors,  sputum  and  wash  basin 
drains.  The  latter  should  be  flushed  and  freed  from  accumulation  by  the  use  of 
superheated  steam  at  high  pressure.  The  slow  discharge  from  Pullman  wash- 
basins resulting  from  obstructive  accumulations  is  familiar  to  almost  every  pas- 
senger, but  is  not  surprising  when  one  witnesses  each  morning  the  use  of  the 
basins  for  spitting  and  teeth  cleaning  purposes.  Anti-spitting  and  a  special  waste 
sink  in  the  wash  room  for  such  use  would  be  a  decided  hygienic  improvement. 

I  suggest  as  a  precautionary  and  preventive  measure,  that  persons  presumably 
healthy,  should  voluntarily  and  as  a  routine  health  matter,  have  a  thorough 
examination  made  at  stated  intervals  to  determine  the  presence  or  absence  of 
tubercular  infection.  I  believe  that  a  large  percentage  of  the  grave  or  fatal 
cases  of  tuberculosis  could  be  cured  if  diagnosticated  and  treated  at  the 
earliest  determinable  stage  of  the  disease.  Unrecognized,  mild  and  incipient  cases 
of  tuberculosis,  are  causative  of  a  greater  zone  of  infection  than  are  advanced 
cases  which  are  under  modern  treatment  and  control. 

INFORMATION  REGARDING  MALARIA.  PRESENTED  IN  ACCORD- 
ANCE WITH  PROVISIONAL  PROGRAM,  BY  SURGEON-GENERAL 
WALTER  WYMAN,  U.  S.  PUBLIC  HEALTH  AND  MARINE  HOS- 
PITAL SERVICE. 

Malaria,  though  widely  distributed  throughout  the  United  States,  is  absent  in 
certain  areas  and  exceedingly  rare  in  others.  Its  exact  geographical  distribution 
has  as  yet  not  been  determined.  Such  a  study  involves  an  exact  determination 
of  the  distribution  of  the  anopheles  mosquito,  and  this  subject  is  now  receiving 
the  attention  of  Prof.  L.  O.  Howard,  Chief  of  the  Bureau  of  Entomology, 
Department  of  Agriculture,  and  Consulting  Entomologist  of  the  United  States 
Public  Health  and  Marine  Hospital  Service. 

The  disease  prevails  along  the  coast  of  New  Jersey,  Maryland,  the  Carolinas, 
and  in  large  areas  of  the  Gulf  States.  It  is  also  prevalent  in  certain  districts 
of  the  Mississippi  Valley.  It  has  a  limited  distribution  in  the  Pacific  Coast 
States,  being  confined  to  certain  valleys.  In  California  it  is  rarely  encoun- 
tered except  in  the  San  Joaquin  and  Sacramento  Valleys.  In  these  latter  areas 
efforts  are  being  made  to  destroy  the  breeding  places  of  mosquitoes.  Farmers' 
associations  and  inhabitants  of  towns  are  being  taught  to  fight  the  mosquito, 
and  these  insects  are  being  eliminated,  so  that  in  places  where  malaria  formerly 
prevailed  there  are  now  few,  if  any,  cases  being  reported.  In  this  work  the 
oiling  of  pools,  screening  of  water  containers,  and  drainage  of  breeding  places 
has  been  practiced. 

In  the  Central  States  economic  conditions  have  led  to  the  drainage  of  marsh 
lands,  and  consequently  the  land  that  was  formerly  a  swamp  is  now  under  cul- 
tivation. During  the  past  ten  years  these  measures  have  had  a  noticeable 
influence  in  reducing  the  prevalence  of  the  disease.  In  the  Eastern  States, 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  217 

particularly  Massachusetts,  New  York  and  New  Jersey,  systematic  campaigns 
for  the  extermination  of  mosquitoes  have  been  carried  on.  The  two  latter 
States,  during  1906,  enacted  laws  for  the  suppression  of  mosquito  breeding 
places,  and  for  the  drainage  of  swamps  and  other  lowlands.  The  American 
Mosquito  Extermination  Society,  a  national  organization,  has  be.en  actively  en- 
gaged for  several  years  in  a  campaign  against  these  pests.  It  has  been  influen- 
tial in  securing  the  ditching  and  oiling  of  many  low  areas,  and  in  addition  dis- 
tributes literature  on  the  subject. 

Coincident  with  the  acceptation  of  the  doctrine  of  the  transmission  of  yellow 
fever  by  the  Stegomyia  colopus,  measures  were  taken  for  the  destruction  of 
this  mosquito,  which  has  a  beneficial  influence  in  the  elimination  of  anopheles 
breeding  grounds  and  reduction  of  the  malaria  carrying  mosquito. 

INFORMATION  REGARDING  TRACHOMA.  PRESENTED  IN  AC- 
CORDANCE WITH  THE  PROVISIONAL  PROGRAM,  BY  SURGEON- 
GENERAL  WALTER  WYMAN,  U.  S.  PUBLIC  HEALTH  AND 
MARINE  HOSPITAL  SERVICE. 

The  increasing  prevalence  of  trachoma  in  the  United  States  attracted  wide- 
spread attention  for  some  years  prior  to  1897.  Cases  and  outbreaks  of  the  dis- 
ease, especially  among  school  children  and  the  alien  population,  had  been  noted 
by  numerous  observers. 

It  was  found  to  be  rather  frequent  along  the  Atlantic  seaboard,  especially  in 
our  large  maritime  cities,  and  practically  always  in  persons  either  of  foreign 
birth  or  foreign  parentage.  It  has  been  recognized  for  many  years  that  the 
disease  is  transmissible  from  one  person  to  another,  and  its  presence  was  un- 
doubtedly due  to  the  importation  of  cases  among  arriving  aliens. 

Owing  to  the  westward  migratory  movements  of  this  portion  of  the  popula- 
tion foci  of  the  disease  were  established  at  different  points  in  the  interior  of  the 
United  States.  In  certain  restricted  areas  of  Southern  Illinois  and  in  the  moun- 
tains of  Kentucky  and  West  Virginia  the  disease  has  become  epidemic.  These 
are  the  only  instances  known  in  which  the  disease  is  endemic  among  persons  of 
strictly  American  parentage,  and  even  here  the  evidence  is  in  favor  of  the  belief 
that  it  was  originally  imported  and  has  since  been  fostered  by  the  comparative 
poverty  and  lack  of  medical  facilities  prevailing  in  those  sections. 

Fewer  cases  had  been  observed  among  native  born  Americans,  and  the  in- 
crease mentioned  above  was  attributed  to  the  influx  of  a  large  alien  population 
from  countries  whose  inhabitants  are  ravaged  by  the  disease. 

During  the  past  twenty-five  years  immigrants  have  come  from  as  many  coun- 
tries. During  the  first  fifteen  years  of  this  quarter  of  a  century  the  bulk  of 
immigration  came  from  Northern  Europe,  principally  Germany,  Scandinavia, 
and  the  British  Isles — countries  in  which  trachoma  is  relatively  infrequent. 
During  the  past  twelve  years  the  tide  of  immigration  from  Southern  Europe 
has  been  steadily  increasing  until  at  the  present  time  the  larger  part  of  the 
alien  population  arriving  in  the  United  States  originates  in  Italy,  Austria- 
Hungary,  the  Russian  Empire,  and  countries  bordering  on  the  Northern  and 
Eastern  shores  of  the  Mediterranean.  This  change  in  the  source  of  arriving 
aliens  no  doubt  accounted  for  any  increase  in  the  disease. 

Prior  to  1897  ophthalmologists  and  representative  bodies  urged  that  immediate 
steps  be  taken  to  prevent  the  further  importation  of  trachoma  in  the  belief 
that  such  precautions  would  be  an  important  factor  in  the  elimination  of  the 
disease  from  the  country.  In  the  examination  of  immigrants  sufficient  evidence 
had  accumulated  to  prove  the  contagious  character  of  the  disease,  and  no  doubt 
existed  as  to  the  seriousness  of  its  sequellae.  It  was  also  believed  that  fresh 
importations  would  only  serve  to  propagate  the  disease  and  throw  additional 
burdens  on  the  State. 

The  Surgeon-General  of  the  Public  Health  and  Marine  Hospital  Service 
therefore  addressed  a  communication  to  the  Commissioner-General  of  Immi- 
gration on  October  30,  1897,  calling  attention  to  the  contagiousness  of  the  dis- 
ease, and  as  a  result,  it  was  classified  as  "dangerous  contagious"  in  accordance 
with  the  immigration  law  of  1891,  thus  making  mandatory  the  deportation  of 
all  arriving  aliens  so  afflicted. 

Since  that  time  thousands  of  aliens  afflicted  with  trachoma  have  been  certified 
by  medical  officers  and  excluded  from  landing  at  United  States  ports. 


2l8  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

The  physical  and  mental  examinations  of  arriving  aliens  are  made  by  medical 
officers  of  the  U.  S.  Public  Health  and  Marine  Hospital  Service  who  are 
responsible  for  the  efficiency  of  such  examinations.  The  examinations  are  con- 
ducted in  conjunction  with  the  inspection  instituted  by  the  Immigration  Service 
and  in  accordance  with  official  instructions  issued  for  their  guidance.  The 
medical  examinations  are  made  by  daylight,  and  never,  except  in  an  emergency, 
is  artificial  light  used.  The  inspection  is  so  arranged  that  the  alien  is  sub- 
jected to  a  primary  medical  examination  at  which  the  eyelids  are  averted.  At 
this  examination  every  alien  presenting  symptoms  of  any  disease  is  detained  for 
further  examination.  These  persons  are  examined  a  second  time  in  rooms  espe- 
cially set  aside  for  the  purpose.  At  this  time,  records  of  physical  defects  are 
made  for  the  information  of  the  immigration  inspectors  and  for  future  refer- 
ence. 

Cases  of  undoubted  trachoma  are  immediately  certified,  and  cases  of  acute 
inflammation  of  the  conjunctiva  presenting  suspicious  symptoms  are  held  in 
hospital  pending  a  definite  diagnosis. 

It  is  of  the  highest  importance  both  in  the  interest  of  the  alien  and  the  State 
that  a  correct  diagnosis  be  established  in  every  case,  as  the  certification  of 
trachoma  accomplishes  the  deportation  of  the  alien  concerned.  Suspicious  cases 
are,  therefore,  held  in  hospital  under  observation  for  a  period  of  ten  days  or 
longer  as  may  be  necessary.  Simple  inflammatory  conditions  of  the  conjunctiva 
improve  rapidly  and  are  well  within  a  few  days,  while  trachoma  is  notorious  for 
its  chronicity  and  resistance  to  remedial  measures. 

In  these  examinations  and  in  the  subsequent  disposition  of  patients  great 
care  is  observed  to  prevent  the  spread  of  the  disease  to  healthy  persons.  Anti- 
septic solutions  are  in  constant  use  during  the  examination  and  the  patients  while 
in  hospital  are  grouped  in  separate  wards  set  aside  for  the  purpose. 

In  addition  to  the  measures  taken  at  ports  of  arrival  in  the  United  States 
officers  are  stationed  at  some  foreign  ports  to  prevent  the  embarkation  of  per- 
sons suffering  with  trachoma  or  other  dangerous  contagious  diseases.  As  a 
result  of  these  examinations  fewer  cases  are  now  found  among  arriving  immi- 
grants, as  the  steamship  companies  themselves  make  considerable  effort  to 
prevent  the  embarkation  of  persons  so  afflicted.  This  action  on  the  part  of  the 
steamship  companies  is  one  of  self-protection,  as  the  immigrant  is  returned  at 
the  expense  of  the  steamship  company,  and  in  addition  the  company  is  subject 
to  a  fine  of  $100.00  for  the  importation  of  each  and  every  alien  afflicted  with  a 
loathsome  or  dangerous  contagious  disease  if  it  is  established  that  the  existence 
of  such  disease  might  have  been  detected  by  means  of  a  competent  medical 
examination  at  the  time  of  foreign  embarkation. 

The  beneficent  results  of  the  enforcement  of  the  immigration  laws  are  shown 
in  the  annual  reports  both  of  the  Surgeon -General  of  the  Public  Health  and 
Marine  Hospital  Service  and  of  the  Commission-General  of  Immigration  during 
the  past  ten  years.  During  the  fiscal  year  ended  June  30,  1906,  alone,  29,600 
cases  of  trachoma  were  prevented  from  embarking  at  foreign  ports,  and  1,600 
cases  of  the  disease  were  certified  as  having  trachoma  upon  arrival.  Statistics 
compiled  by  Dr.  A.  E.  Davies  of  New  York  revealed  the  fact  that  prior  to  the 
classification  of  trachoma  as  a  dangerous  contagious  disease  by  the  United 
States  Government  in  1897,  thus  making  mandatory  the  deportation  of  all 
aliens  arriving  who  are  so  afflicted,  the  percentage  of  trachoma  in  half  a  million 
cases  of  diseases  of  the  eye  investigated  by  him  was  4  per  cent.  Within  three 
years  after  this  restrictive  measure  was  instituted  an  examination  of  nearly 
one  hundred  thousand  cases  revealed  the  presence  of  but  a  little  over  2  per  cent 
of  cases  of  trachoma. 

Health  officers  are  alive  to  the  importance  of  preventing  the  spread  of 
trachoma  among  school  children,  and  in  many  of  the  cities,  especially  those 
containing  a  large  alien  population,  regular  examinations  are  made,  and  children 
afflicted  with  the  disease  are  debarred  from  the  schools  until  they  are  cured.  In 
some  cities  special  hospitals  have  been  established  for  the  treatment  of  persons 
so  afflicted. 

It  is  easier  to  prevent  trachoma  than  to  cure  it.  When  we  consider  that  the 
presence  of  the  disease  in  any  area  practically  implies  its  previous  importation 
and  that  in  some  sections  of  Europe  from  which  immigrants  come  60  per  cent 
of  all  cases  of  blindness  are  due  to  this  disease,  measures  looking  to  its  exclu- 
sion need  no  defense.  It  is  believed,  therefore,  that  the  best  national  prophylaxis 
for  republics  in  the  Western  Hemisphere  is  the  exclusion  of  aliens  suffering 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  219 

from  trachoma.  By  this  means  the  establishment  of  new  foci  is  prevented, 
and  the  danger  of  its  appearance  in  the  public  schools  is  diminished — an  import- 
ant consideration  when  we  remember  that  the  children  of  the  present  are  to 
constitute  the  active  producing  members  of  the  community  of  the  future,  and 
that  the  general  status  of  the  future  community  is  dependent  upon  the  degree 
of  intelligence  which  we  are  able  by  education  to  confer  upon  our  children. 
School  children  attacked  by  this  disease  must  be  excluded  from  school  attend- 
ance for  long  periods  at  a  time  when  their  faculties  can  but  illy  afford  to  lose 
the  training  if  they  are  to  develop  their  highest  qualifications  as  useful  social 
units. 

Finally,  the  arriving  alien,  by  reason  of  his  affliction,  inherits  an  environment 
of  comparative  poverty  and  squalor.  He  is  unable  to  contribute  his  due  portion 
to  the  industrial  and  mental  development  of  the  state,  and  his  very  presence  is, 
therefore,  a  factor  in  reducing  the  standard  of  the  civilization  of  the  country 
to  which  he  comes. 


REPORT  PRESENTED  BY  DR.  E.  FERNANDEZ  ESPIRO, 
DELEGATE  FROM  URUGUAY. 

ORDINARY  CONTAGIOUS  DISEASES. 

I.  Among  the  ordinary  contagious  diseases  most  frequently  observed  in  Para- 
guay are  tuberculosis,  typhoid  fever,  smallpox,  scarlet  fever,  diphtheria,  measles, 
and  whopping  cough. 

We  will  treat  of  each  of  them  commencing  with  tuberculosis. 

Tuberculosis. 

t  Of  all  the  diseases  which  have  been  mentioned,  the  one  that  causes  most  vic- 
tims and  is  most  generalized,  is  unquestionably  tuberculosis.  In  fact,  figures 
relating  to  deaths  from  contagious  diseases,  during  the  last  ten  years,  show  that 
the  number  of  deaths  from  tuberculosis  amounted  to  9,546,  while  the  number 
of  deaths  caused  by  typhoid  fever,  scarlet  fever,  diphtheria  and  smallpox 
amounted  to  1,983,  694  669,  and  559,  respectively. 
The  following  table  shows  the  number  of  deaths  during  the  aforesaid  period: 

DEATHS. 

1897  to  1906. 

First  five  years.  Second  five  years. 

1897 962  1902 954 

1898 909  1903... 1,010 

1899 842  1904 919 

1900 917  1905 966 

1901 907  1906 1,160 


4,537  •      5,009 

Total  for  ten  years 9.546 

The  great  difference  observed  between  the  mortality  from  tuberculosis  and 
from  other  contagious  diseases,  has  been  noticed  for  some  time,  with  the  aggra- 
vating circumstance  that  it  tends  to  be  more  marked  from  year  to  year,  to 
such  an  extent  that,  the  number  of  deaths  from  tuberculosis  has  almost 
equaled,  in  some  rural  departments,  the  total  deaths  from  all  other  contagious 
diseases.  However,  we  should  call  attention  to  the  fact  that  this 
does  not  happen  in  Uruguay  alone,  but  the  same  is  true  of  other  countries, 
and  perhaps  in  a  greater  proportion,  because  the  development  of  the  disease 
is  greater  in  said  countries,  and  therefore,  the  average  mortality  is  much 
greater. 

Yet,  it  can  not  be  denied  that  the  spread  of  the  disease  continually  increases, 
though  not  to  an  uncommon  extent,  but  sufficient  to  particularly  call  the  atten- 
tion of  the  sanitary  authorities  to  it. 

In  regard  to  the  measures  which  have  been  adopted  foi  combatting  tuber- 


220  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

culosis,  I  beg  to  state  that  until  1896  there  was  no  sanitary  provision  requiring 
physicians  to  report  cases  of  that  disease.  It  was  about  the  middle  of  said  year 
that  the  ordinance  making  compulsory  the  report  of  contagious  diseases,  among 
which  pulmonary  and  laryngeal  tuberculosis  was  included,  was  promulgated. 

Through  one  of  the  wise  provisions  of  the  rules  and  regulations  of  the  Sani- 
tary Law,  the  report  of  cases  of  tuberculosis  was  not  allowed  to  be  made  public, 
so  that  the  personnel  of  the  Bureaus  who  receive  the  reports,  are  not  allowed 
to  make  public  the  names  or  domiciles  of  the  patients  except  to  persons  duly  au- 
thorized. 

After  taking  these  measures  by  means  of  which  the  sanitary  authorities  have 
been  able  to  discover  many,  if  not  all,  of  the  cases  of  tuberculosis  which  have 
occurred,  it  became  necessary  to  decree  other  provisions  in  order  to  generalize 
the  information  relating  to  the  transmission  of  said  disease,  and  to  the  precau- 
tions which  should  be  adopted  in  order  to  prevent  it. 

With  this  end  in  view,  the  National  Board  of  Health  approved  the  following 
prophylactic  measures  in  1898: 

GENERAL  RULES 

For  Preventing  the  Spread  of  Tuberculosis  by  Persons  Afflicted  Wiih  Pulmonary 
and  Laryngeal  Consumption. 

1.  Of  all  forms  of  tuberculosis,  pulmonary  and  laryngeal  consumption  are 
the  two  forms  which  more  easily  transmit  the  infection. 

2.  The  infectious  agent  or  microbe  is  found  in  the  sputum  of  patients,  and 
may  transmit  the  disease  when  the  sputum  is  dry. 

3.  When  the  sputum  is  dry,  it  spreads  the  infectious  agent  through  the  air, 
and  becomes  a  part  of  the  dust,  and  in  entering  the  lungs  by  the  respiratory 
organs,  frequently  finds  favorable  conditions  for  procreating  the  disease. 

Persons  afflicted  with  bronchitis  or  cough  are  more  predisposed  to  contract 
the  infection. 

4.  In  order  to  prevent  patients  from  spreading  the  infection,  it  is  necessary 
to  destroy  the  germs  contained  in  the  sputum  as  soon  as  they  are  expelled  by 
the  cough. 

5.  To  obtain  this  result,  the  sputum  should  not  be  thrown  in  any  other  place 
than  the  cuspidor  or  other  receptacle  provided  for  that  purpose. 

6.  The  best  cuspidor  or  receptacle  is  the  one  which  allows  the  sputum  to 
sink  in  such  liquid  as  it  contains,  without  sliding  over  the  walls  of  the  cuspidor. 

7.  Cuspidors  should  contain  an  antiseptic  liquid  capable  of  dissolving  the 
sputum  and  killing  the  germs. 

Lysol  and  creoline  dissolved  in  the  proportion  of  50  grams  per  liter  of  water 
possesses  both  qualities,  and  have  the  advantage  of  not  affecting  metals. 

8.  When  neither  lysol  nor  creoline  can  be  employed,  the  cuspidors  must  con- 
tain water,  but  in  such  case,  since  the  sputum  retains  the  liver  germs,  boiling 
water  should  be  employed  to  wash  the  cuspidors. 

9.  The  contents  of  the  cuspidors  should  be  emptied  in  cesspools,  thus  avoid- 
ing their  overflow  in  any  other  place  where  they  might  become  dry  or  come  in 
contact  with  domestic  animals,  which  can  also  contract  tuberculosis  and  trans- 
mit the  disease  to  persons. 

10.  Clothing  and  bedclothes  used  by  the  patients  should  be  immersed  in  a 
solution  of  bichloride  of  mercury  in  the  proportion  of  I  per  thousand,  or  boiled 
for  a  quarter  of  an  hour  before  they  are  sent  to  be  washed. 

n.  In  general,  every  place  where  the  patient  has  expectorated  should  be 
thoroughly  washed  with  a  solution  of  bichloride  in  the  proportion  of  2  per 
thousand,  or  with  boiling  water  as  circumstances  may  permit. 

Care  should  be  taken  not  to  sweep  the  rooms,  nor  dust  the  furniture,  but  the 
rooms  should  be  cleaned  with  wet  rags  immersed  in  the  aforesaid  solution 
before  they  are  rung  or  dried. 

Precautionary  Measures  Taken  at  Schools,  Barracks,  Asylums,  Hospitals, 

Jails,  Etc. 

12.  The  use  of  cuspidors  should  be  compulsory,  both  in  the  case  of  healthy 
persons  and  in  the  case  of  the  sick. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  221 

Spittoons  should  be  of  earthenware,  enameled  iron  or  other  similar  material, 
and  should  contain  water,  or  the  aforesaid  antiseptic  solution,  and  must  be  kept 
absolutely  clean. 

Prophylactic  Measures. 

Unoccupied  houses  where  consumptives  have  lived,  should  not  be  allowed  to 
be  leased  again  without  first  being  officially  disinfected. 

14.  In  order  to  comply  with  the  foregoing  provision,  the  proper  authorities 
shall  notify  the  proprietors  of  the  houses  which  should  be  disinfected. 

15.  When  a  pulmonary  or  laryngeal  consumptive  dies,  a  thorough  disinfec- 
tion of  the  patient's  room  should  be  made,  without  prejudice  to  also  disinfecting 
the  other  rooms  of  the  house. 

In  addition  to  these  provisions,  the  National  Board  of  Health  has  ordered  that, 
at  stated  times,  the  disinfection  of  the  houses  occupied  by  consumptives  be 
made,  and  to  that  end  has  issued  the  following  rules: 

1.  Compulsory  disinfection  of  the  domiciles  of  consumptives  who  have  been 
attended  by  the  physicians  of  the  Board  of  Health  detailed  for  that  purpose, 
and  of  those  who  apply  to  the  dispensaries  of  the  League  against  Tuberculosis. 

2.  The  houses  shal^  be  partially  disinfected  fortnightly. 

3.  A  receptacle  and  an  antiseptic  liquid  shall  be    furnished    in    which    to 
immerse  the  clothing  used  by  consumptives,  and  said  liquid  shall  be  renovated 
whenever  it  shall  be  deemed  advisable. 

4.  The  disinfection  shall  be  made  officially,  and  to  that  end  the  Economic- 
Administrative  Board  shall  take  such  measures  as  it  may  deem  proper. 

These  measures,  the  application  of  which  had  to  be  limited  to  the  houses 
occupied  by  consumptives  who  received  free  medical  attendance,  must  neces- 
sarily be  made  applicable  later  on  to  other  domiciles  in  the  same  condition, 
even  though  they  are  occupied  by  persons  of  means,  because  the  National  Board 
of  Health  so  requires,  and  also  because  it  should  be  so,  as  otherwise  many 
occupied  by  consumptives  would  escape  said  periodical  disinfection,  which  is 
just  as  essential  as  the  final  disinfection. 

There  is  also  in  force  an  ordinance  issued  by  the  Economic- Administrative 
Board  of  the  Department  of  Montevideo,  which  makes  the  disinfection  of  the 
clothes  and  bedclothes  used  by  the  patient  compulsory,  as  well  as  the  carpets, 
mattresses,  and  all  furniture  used  by  him,  such  as  beds,  bedroom  tables,  etc., 
sold  privately  or  at  a  public  auction. 

It  is  evident  that  said  provision  has  not  been  put  in  force  for  the  sole  pur- 
pose of  preventing  articles  belonging  to  consumptives  being  used  without  having 
been  previously  disinfected,  but  that  said  provision  applies  also  to  articles  used 
by  patients  of  all  contagious  diseases;  but  since  it  meets  one  of  the  many  de- 
mands of  the  prophylaxis  of  tuberculosis,  I  thought  I  would  take  advantage  of 
this  opportunity  to  call  attention  to  it,  the  more  so,  since  it  refers  to  one  of 
the  several  provisions  applied  for  the  purpose  of  entirely  destroying  the  germs 
of  said  disease. 

Below  will  be  found  another  important  ordinance  relating  to  the  sanitary 
vigilance  of  inns  and  dairies,  and  therefore,  to  the  inspection  and  tuberculiza- 
tion  of  cows. 

Ordinance  Concerning  the  Sanitary  Vigilance  of  Inns  and  Dairies. 

Article  I.  No  animal  that  can  be  used  in  the  exploitation  of  the  milk  indus- 
try, shall  be  allowed  to  be  used  in  the  inns  or  dairies  of  the  Department,  without 
the  express  consent,  which  shall  be  granted  after  a  veterinary  examination  and 
the  tuberculization  of  the  animal,  made  by  the  personnel  of  the  Veterinary 
Division  of  the  Municipal  Bacteriological  Service. 

Art.  2.  The  inspection  referred  to  in  Article  I  will  apply  to  animals  to  be 
used  at  the  inns  of  the  city,  at  such  place  as  the  Board  of  Health  may  desig- 
nate, where  they  shall  be  kept  for  inspection  as  long  as  may  be  necessary  to 
determine  the  condition  of  their  health. 

Art.  3.  It  shall  be  the  duty  of  the  owners  of  inns  and  dairies  to  bring,  at 
their  own  expense,  to  the  place  of  inspection  to  which  Article  2  refers,  such 
animals  as  are  kept  in  their  establishments  in  the  cases  provided  for  by  this 
ordinance  or  by  the  rules  and  regulations  of  the  Service,  and  to  furnish  samples 
of  the  milk  in  order  to  make  the  analysis  whenever  the  Bureau  shall  so  direct 


222  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Art.  4.  The  expenses  of  board,  tuberculization,  etc.,  incurred  by  the  inspec- 
tion prescribed  in  Articles  I  and  3,  shall  be  borne  by  the  owners  of  the  animals, 
in  accordance  with  such  tariff  as  the  Economic-Administrative  Board  may 
approve. 

Art.  5.  Animals  which,  after  treatment  by  tuberculization,  still  show  clinical 
symptoms  of  infectious  tuberculosis,  such,  for  instance,  as  cough,  difficult 
breathing,  sores  on  the  teats,  swollen  glands,  etc.,  and  also  when  these  symptoms 
permit  the  diagnosis  to  be  made,  even  though  reaction  has  not  taken  place. 

a.  When  the  diagnosis  has  been  confirmed  by  the  autopsy,  the  carcass  shall 
be  totally  or  partially  destroyed,  the  residue  belonging  to  the  interested  party. 

b.  When  the  condition   of  the  meat   warrants   its   use  for  consumption,   its 
sale  shall  be  authorized  in  accordance  with  the  provisions  in  force  regarding 
the  matter. 

Art.  6.  Consumptive  animals  merely  showing  a  reaction  caused  by  the  treat- 
ment by  tuberculization,  shall  be  rejected,  and  branded  on  the  back  of  the  left 
ear. 

Suspected  animals  shall  likewise  be  rejected,  marking  them  so  that  the  Bureau 
may  easily  recognize  them. 

Animals  of  the  last  class  shall  not  be  returned  for  inspection  until  after 
the  lapse  of  a  period  of  two  months1. 

Art.  7.  The  classification  of  the  two  groups  of 'animals  mentioned  in  the  fore- 
going articles,  according  to  the  result  of  the  tuberculosis  test,  shall  be  made 
in  conformity  with  the  opinion  accepted  by  the  Experimental  Health  Institute 
(Ordinance  of  the  National  Board  of  Health  No.  83). 

Art.  8.  The  use  and  sale  of  milk  from  the  animals  referred  to  in  Article  6, 
which  shall  only  be  kept  in  distant  places — at  least  5  kilometers — from  the 
nearest  inn  or  dairy,  is  hereby  prohibited. 

Art.  9.  Neither  shall  said  animals  be  worked  in  slaughter-houses  where 
veterinary  inspection  is  not  made. 

Art.  10.  The  owners  of  condemned  animals  shall  receive  therefor  such 
equitable  compensation  as  the  Economic-Administrative  Board  may  fix,  deduct- 
ing the  amount  charged  for  board,  with  the  exception  of  animals  notoriously 
sick,  suffering  from  a  severe  cough,  bad  general  condition,  etc.,  and  those 
which  have  been  branded  by  the  Bureau  at  previous  inspections1. 

Art.  ii.  The  Bureau  shall  direct  the  veterinaries  under  its  charge,  to  peri- 
odically inspect  all  the  establishments  of  the  Department  which  supply  milk. 

Sick  or  suspected  animals  shall  be  removed  at  the  earliest  possible  date,  and 
sent  to  the  proper  place  for  inspection  whenever  the  proper  authority  shall  so 
direct. 

Art.  12.  At  the  request,  and  at  the  expense  of  the  party  in  interest,  the  ani- 
mals rejected  by  the  Bureau  shall  be  permitted  to  work  at  the  place  of  inspec- 
tion in  accordance  with  the  provisions  of  Article  5,  paragraphs  a  and  b,  with  the 
previous  consent  of  the  Northern  Railway  and  Tramway  Company. 

Art.  13.  It  shall  be  the  duty  of  the  owners  of  inns  and  dairies  to  report  to 
the  Bureau  directly  or  through  the  health  officials,  concerning  all  animals 
having  visible  symptoms  of  the  disease,  such  as  cough,  fatigue,  diarrhea,  fetid 
excrements  after  parturition,  leanness,  and,  more  especially,  any  abnormal  symp- 
toms of  the  udder,  and  they  shall  likewise  report  immediately  concerning  those 
dying  in  the  establishment. 

Art.  14.  The  animals  shall  be  kept  entirely  clean  and  well  fed  with  forage 
of  good  quality,  the  use  of  the  residues  of  starch  factories,  breweries,  alcohol 
distilleries,  sugar  factories,  musty  or  fermented  feed,  being  prohibited,  and  the 
use  of  all  kinds  of  substances  capable  of  transmitting  harmful  effects  to  the 
milk  or  of  altering  its  organpleptic  character  or  unfavorably  modifying  its 
composition,  are  likewise  prohibited. 

Art.  15.  The  stalls  and  the  receptacles  used  for  feeding  the  animals  shall 
be  metallic,  or  of  any  other  water-proof  material,  and  there  must  be  one  for 
each  animal  and  it  must  be  kept  entirely  clean. 

Art.  16.  Whenever  among  animals  kept  in  inns  and  dairies,  any  case  of  in- 
fectious disease  develops,  such  as  carbuncle,  apthous  fever,  tuberculosis,  etc., 
or  repeated  cases  of  tuberculosis  occur  among  animals  coining  from  the  same 
establishment,  the  disinfection  service  shall  disinfect  the  stable  without  preju- 

*Thi»  proviiion  waa  modified  by  an  executive  decree  of  December  8,  1903. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  22$ 

dice  to  the  adoption  of  other  necessary  measures,  and  the  owner,  in  addition, 
shall  employ  such  sanitary  measures  as  the  Board  of  Health  may  require. 

Art,  17.  Such  establishments  as,  notwithstanding  the  measures  adopted,  be- 
come contaminated  and  produce  cases  of  tuberculosis,  shall  be  closed  within  a 
period  of  six  months,  and  shall  not  be  reopened. 

A  similar  decision  shall  be  made  immediately  whenever  the  interested  parties 
fail  to  comply  with  the  provisions  of  the  foregoing  article. 

Art.  18.  Whenever  a  case  of  infectious  disease  occurs,  the  report  of  which 
is  compulsory,  such  for  instance,  as  smallpox,  measles,  scarlet  fever,  whooping- 
cough,  typhoid  fever,  puerperal  fever,  erysipelas,  pulmonary  or  laryngeal  con- 
sumption, among  persons  living  in  the  inn  or  dairy,  or  who  are  in  contact 
with'  the  personnel  thereof,  the  prophylactic  measures  prescribed  by  the  rules 
and  regulations  in  force  shall  be  applied,  and  the  establishment  shall  be  closed 
if  it  is  deemed  necessary. 

The  patients  or  convalescents  of  said  diseases,  as  well  as  those  having  sore 
hands  susceptible  of  contaminating  the  milk,  shall  be  excluded  from  service 
in  inns  and  dairies. 

At  the  request  of  the  Board  of  Health  the  personnel  of  suspected  establish- 
ments shall  be  subject  to  an  examination  by  the  municipal  physician,  who  shall 
report  as  to  the  measures  which  should  be  adopted  in  each  case. 

Art.  19.  The  person  who  milks  the  cow,  before  doing  so,  shall  have  clean 
hands,  and  see  that  the  udder  and  teats  of  the  animal  are  also  entirely  clean, 
and  he  shall  also  keep  constantly  clean  the  vessels  and  all  kinds  of  receptacles 
in  which  the  milk  is  gathered,  measured  and  preserved. 

All  these  receptacles  shall  be  kept  out  of  the  barn  in  a  suitable  place  pro- 
tected from  all  contamination. 

Art.  20.  It  shall  be  the  duty  of  owners  of  establishments  for  the  deposit  or 
sale  of  animals,  to  report  to  the  health  officers  the  number  of  all  cattle  housed 
in  them. 

Art.  21.  It  shall  be  the  duty  of  the  health  officers  to  visit  daily  said  places, 
reporting  to  the  General  Inspection  Bureau  on  the  blank  forms  furnished  for 
that  purpose  by  the  Municipal  Bacteriological  Service  forwarding  said  report 
thereto  on  the  same  day. 

Art.  22.  Articles  i,  2,  4,  5,  6,  7,  and  9  of  the  present  ordinance  shall  be 
applicable  to  milch  cows  for  private  use. 

In  case  private  persons  desire  to  have  their  cows  inspected  at  home,  they 
shall  pay  such  additional  amount  as  may  be  fixed  for  that  purpose1. 

Art.  23.  Such  claims  as  may  arise  by  reason  of  the  application  of  this  ordi- 
nance, and  the  annexed  rules  and  regulations,  shall  be  made  in  writing  to  the 
Board  of  Health  within  three  days  after  the  action  taken  by  the  Bureau,  and 
after  the  expiration  of  that  term  no  claim  will  be  admitted. 

Art.  24.  The  analysis  and  investigations  required  by  the  service  established 
by  this  ordinance  as  well  as  the  organization  and  management  of  said  service, 
are  under  the  control  of  the  Municipal  Bacteriological  Service. 

Art.  25.  The  Board  of  Health  shall,  as  soon  as  practicable,  require  com- 
pliance with  the  provisions  of  this  ordinance  by  all  the  establishments  which 
supply  milk  to  the  department  of  the  Capital,  and  shall  provide  the  service  in 
each  district  with  such  organization  as  it  may  deem  advisable. 

Art.  26.  Until  the  sale  and  use  of  tuberculin  is  effected  under  certain  regula- 
tions, the  application  of  said  substance,  without  the  previous  consent,  in  each 
case,  of  the  Bureau  in  charge  of  the  tuberculization  service  under  such  condi- 
tions as  the  same  may  establish,  is  prohibited2. 

Art.  27.  Each  infraction  of  the  provisions  of  the  present  ordinance  shall  be 
punished  by  a  fine  of  $10,  except  the  provisions  of  Articles  18  and  19,  the  vio- 
lation of  which  shall  be  punished  in  each  case  by  a  fine  of  $4. 

Art.  28.    All  provisions  opposed  to  the  present  ordinance  are  hereby  repealed. 

RULES    AND    REGULATIONS    OF    THE    SERVICE    OF    TUBERCULIZATION    AND    VETERINARY 

INSPECTION. 

Article  i.    In  accordance  with  the  present  rules  and  regulations  each  inn  shall 


resolution    of    August    16,    1902,    of    the    Economic-  Administrative    Board,    fixes    the 
amount  to  be  charged  for  inspection  of  animals  on  the  premises  at  $3.00. 

2See  ordinance  of  August  20,  1901,  on  the  preparation  and  sale  of  tuberculin. 


224  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

be  given  a  certain  number,  which  the  Bureau  shall  specify  in  a  document  issued 
to  the  owner  of  the  establishment. 

Said  certificate  shall  be  placed  where  the  public  can  see  it. 

Art.  2.  After  the  inspection  service,  referred  to  in  Article  I  of  the  ordinance, 
has  shown  that  the  animals  are  in  a  healthy  condition,  and  that  they  give  milk 
of  good  quality,  said  service  shall  issue  a  certificate  of  health  stating  the  num- 
ber of  the  inspection,  the  description  of  each  animal,  and  such  other  data  as  it 
may  deem  pertinent,  without  which  requisite  the  animals  shall  not  be  admitted 
to  the  dairies. 

Art.  3.  The  certificates  of  health  shall  constitute  the  sole  evidence  that  the 
interested  parties  have  complied  with  Article  I  of  the  ordinance  concerning  the 
sanitary  inspection  of  inns  and  dairies,  and  shall  be  valid  for  a  term  of  twelve 
months,  but  only  for  the  inn  whose  number  appears  therein1. 

Before  the  expiration  of  this  term,  the  animals  in  question  shall  be  removed 
from  the  inn  or  dairy,  or  taken  anew  to  the  place  of  inspection,  to  be  submitted 
to  a  new  examination. 

Art.  4.  In  the  case  of  suspected  establishments  and  until  the  same  are  in  a 
complete  state  of  sanitation,  the  examination  of  such  animals  as  may  be  housed 
therein,  shall  be  made  again,  six  months  after  their  admission. 

In  all  inns  and  dairies,  after  the  lapse  of  two  months,  the  examination  of 
animals  admitted  therein  conditionally,  may  be  ordered. 

Art.  5.  The  certificate  of  health  shall  be  posted  either  on  a  board  with  a 
glass  or  hinged  cover,  or  they  may  be  attached,  one  by  one,  to  the  leaves  of  a 
scrap  book,  which  shall  be  kept  permanently  exposed  in  the  barn  or  office  in  a 
place  easily  visible  and  accessible. 

Art.  6.  It  shall  be  the  duty  of  the  owners  of  inns  or  dairies  to  show  certifi- 
cates of  health  of  all  the  animals  in  their  establishment  whenever  the  officers  of 
the  Municipal  Bacteriological  Service,  or  of  the  Board  of  Health,  shall  so 
require. 

Whenever,  for  any  reason,  they  are  unable  to  comply  with  this  provision  at 
once,  they  shall  present  said  certificates  to  the  Bureau  within  24  hours. 

Art.  7.  Certificates  of  health  that  have  been  deteriorated,  lost  or  become 
void  by  transfer,  shall  be  replaced  whenever  the  interested  parties  furnish  the 
necessary  data  verifying  that  they  have  complied  with  the  provisions  of  Article 
i  of  the  ordinance,  and  by  paying  the  amount  of  the  new  certificate  fixed  by 
the  tariff. 

Art.  8.  Each  inn  or  dairy  shall  be  provided  with  a  special  certificate  stating 
the  date  and  result  of  the  inspection  made  in  said  establishments. 

Said  certificate  shall  be  placed  in  the  office  where  the  public  can  see  it. 

Art.  9.  Any  falsification  of  said  certificates  shall  be  punished  in  accordance 
with  the  law. 

Art.  10.  On  making  their  daily  visits  to  the  inns  and  dairies,  the  officers 
or  assistants  of  the  Board  of  Health  shall  see  if  there  are  animals  without  the 
proper  certificates  and  also  whether  any  of  them  shows  any  visible  symptoms 
of  disease,  and  shall  immediately  report  to  the  General  Inspection  Bureau,  in 
order  to  take  such  action  as  may  be  deemed  advisable. 

Art.  ii.  In  the  case  of  inspection  requested  by  private  persons,  the  provisions 
of  the  present  rules  and  regulations  shall  be  equally  applied,  except  those  men- 
tioned by  Articles  i,  4,  5  and  8. 

Art.  12.  The  decisions  of  the  Bureau  relating  to  the  internal  service,  shall 
be  made  known  to  the  interested  parties  by  means  of  a  notice  fixed  at  the  office 
of  the  Bureau  of  Veterinary  Inspection. 

Art.  13.  The  Bureau  may,  with  the  proper  authorization  of  the  Board  of 
Health,  substitute,  at  any  time,  the  -proof  required  by  Article  i  by  any  other 
means  that  it  may  deem  more  advantageous. 

CONCERNING    REGISTRATION. 

Art.  14.  The  registration  referred  to  in  Article  i  of  the  present  rules  and 
regulations  shall  be  made  every  working  day,  with  the  exception  of  Saturdays 
and  on  the  eves  of  holidays,  at  such  hours  as  may  be  fixed  ten  days  before. 

The  Bureau  may  limit  the  number  of  the  registration,  whenever  the  require- 

1  Modified  by  executive  order  of  December  18,  1903. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  225 

ments  of  the  service  may  demand,  and  may  also  authorize  any  days  and 
hours  in  behalf  of  the  interested  party. 

Art.  15.  All  animals  brought  to  the  Inspection  Bureau  shall  bear  their  cor- 
responding mark,  without  which  they  shall  not  be  acted  upon,  and  those  un- 
branded  may  be  branded  at  the  place  of  inspection. 

Art.  16.  The  registration,  after  paying  the  sum  fixed  by  the  tariff,  shall  be 
made  in  the  order  of  entries,  and  those  not  appearing  to  make  said  registration 
during  the  office  hours  shall  lose  their  turn. 

Art.  17.  Animals  which,  having  been  admitted  to  inns  or  dairies,  have  to  be 
brought  again  to  the  Inspection  Office  by  order  of  the  Bureau,  shall  be  exempt 
from  the  payment  of  the  registration  fee. 

Art.  18.  Animals  rejected  for  other  diseases  than  tuberculosis,  and  which  are 
again  brought  to  the  inspection  office  within  two  months,  are  exempt 
from  the  payment  of  the  registration  fee,  provided  their  owners,  upon  register- 
ing them,  give  the  number  corresponding  to  the  previous  registration. 

The  term  of  twelve  months  mentioned  in  Article  3  shall  be  counted,  in  such 
cases,  from  the  date  of  the  last  tuberculization. 

Art.  19.  It  shall  be  the  duty  of  the  owners  of  animals,  or  their  representa- 
tives, to  furnish  all  such  data  and  documents  as  it  may  be  deemed  necessary  to 
know,  for  the  best  carrying  out  of  the  service,  such  as  the  origin,  destination, 
title  of  ownership,  number  of  the  certificate  of  the  previous  inspection,  if  any 
has  been  made,  or  the  date  of  the  same,  etc. 

The  registration  shall  be  denied  when  this  requisite  is  not  complied  with,  and 
those  who  make  false  declarations  shall  incur  a  fine. 

CONCERNING  PROCEEDINGS  INCIDENTAL  TO  INSPECTION. 

Art.  20.  The  animals  shall  remain  under  inspection  at  least  a  day  and  one- 
half,  counting  from  the  hour  fixed  for  the  beginning  of  the  thermometric  exami- 
nation, and  shall  be  delivered  within  twenty-four  hours  after  the  completion  of 
the  aforesaid  term  except  in  such  exceptional  cases  as  may  require  a  longer 
period  of  time1. 

Art.  21.  Animals  suspected  of  having  been  recently  subjected  to  the  test 
injection,  may  be  detained  under  inspection  for  a  term  of  sixty  days8. 

Art.  22.  Whenever  it  may  be  proper  and  convenient  the  animals  shall  be 
delivered  conditionally,  and  in  such  case  they  shall  not,  under  any  pretext,  be 
removed  from  the  inns  or  dairies,  without  the  written  permit  of  the  Bureau. 

Art.  23.  Animals,  the  admission  of  which  to  inns  or  dairies  has  been  author- 
ized, shall  be  removed  from  the  place  of  inspection  on  the  same  day  the  inspec- 
tion was  made. 

A  term  of  24  hours  shall  be  granted  for  the  removal  of  rejected  animals. 

In  all  cases  the  additional  time  they  remain  in  the  place  of  inspection,  shall 
be  paid  for  in  accordance  with  the  tariff. 

Art.  24.  After  five  days  shall  have  elapsed  from  the  date  on  which  the 
owner  or  manager  of  the  rejected  animal  has  been  notified,  it  shall  be  con- 
sidered abandoned,  and  the  Bureau  shall  sell  it  at  public  auction,  and  after 
deducting  such  expenses  as  are  caused,  the  remainder  shall  be  deposited  in  the 
Treasury  of  the  Board  to  the  credit  of  the  owner,  for  a  term  of  thirty  days. 

CONCERNING  THE  SLAUGHTER  OF  THE  ANIMALS.  I 

Art.  25.  The  animals  referred  to  in  Article  5  of  the  ordinance  on  sanitary 
inspection  of  inns  and  dairies,  shall  be  slaughtered  within  the  term  of  ten  days 
from  the  date  of  the  confiscation. 

Art.  26.  The  Bureau  shall  notify  the  owners  three  days  in  advance,  the  date 
of  the  slaughter  of  their  animals,  the  autopsy  of  which  they  may  witness, 
accompanied  by  a  qualified  veterinarian. 

Art.  27.  The  skinning  of  the  animals  shall  be  at  the  expense  of  the  inter- 
ested parties,  who  shall  immediately  remove  such  parts  as  can  be  used  and  the 
hides,  after  the  proper  disinfection,  and  otherwise  they  shall  be  comprised  in 

1Modified  by  executive  order  of  December  18,   1903. 

2Repealed  by  an  order  of  the  Economic-Administrative  Board  of  October  17,  1903. 


226  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

the  provisions  of  Article  24,  and  in  accordance  with  paragraph  b  of  Article  5 
of  the  ordinance  on  sanitary  inspection  of  inns  and  dairies1. 

Art.  28.  Upon  making  the  registration,  the  veterinarian  connected  with  the 
Service  shall  appraise  each  animal,  the  amount  being  stated  in  the  certificates  of 
registration,  in  accordance  with  the  provisions  of  Article  10  of  the  ordinance. 

The  amounts  of  the  appraisement  shall  be  as  follows : 

For  first  class,  $40;  second,  $25;  third,  $15,  and  fourth,  $8. 

Art.  29.  Such  amount  as  is  paid,  in  accordance  with  Article  10  of  the  ordi- 
nance, for  animals  having  tuberculosis,  as  shown  by  the  autopsy,  shall  repre- 
sent one-half  of  the  value  according  to  appraisement;  and  for  healthy  animals 
the  amount  paid  shall  represent  the  total  of  the  value  fixed  by  appraisement, 
and  in  this  case  the  carcass  shall  belong  to  the  owner2. 

Art.  30.  After  confiscation  has  been  decided  upon,  the  owner  or  his  repre- 
sentative, shall  express  his  acceptance  or  opposition  within  48  hours  after  the 
decision  has  been  notified,  and  after  the  expiration  of  that  period,  the  appraise- 
ment made  by  the  Bureau  shall  be  considered  accepted. 

In  the  case  of  opposition,  the  owner  or  his  representative  shall  appeal  to  the 
Chief  of  the  Service,  who  shall  decide  the  question  in  view  of  the  reasons  set 
forth  by  the  veterinarian. 

Appeals  may  be  taken  from  the  decisions  of  the  Chief  before  the  Board  of 
Health. 

Art.  31.  The  Bureau  shall  deliver  to  the  interested  parties,  as  early  as  pos- 
sible, the  amount  due  him  in  accordance  with  the  law,  taking  a  receipt  there- 
for, and  paying  the  same  out  of  the  collected  funds. 

Art.  32.  On  using  the  sums  collected,  the  Bureau  shall  render  an  account  to 
the  Board  of  Health  of  such  amount  as  it  may  have  disposed  of  for  the  pay- 
ment of  quotas,  etc.,  and,  in  addition,  shall  deliver  monthly  to  the  Auditor's 
Office  the  proper  vouchers. 

Art.  33.  A  fine  of  $10  shall  be  imposed  for  each  infraction  of  the  provisions 
of  these  rules  and  regulations,  and  a  fine  of  $4  for  each  violation  of  Articles 
i,  5  and  8. 

CONCERNING   THE  TARIFF8. 

For  every  animal  that  is  registered  up  to  the  time  of  the  registration,  except 
the  animals  comprised  in  Articles  17  and  18,  there  shall  be  a  charge  of  $1.50. 

CHARGES    FOR   OVER   TIME. 

For  each  day  in  excess  of  twelve  hours,  for  each  animal $0.30 

For  less  than  12  hours,  for  each  animal 0.20 

For  each  duplicate  of  the  certificate  0.20 

INSPECTION  OF  INNS  AND  DAIRIES. 
Decree  Modifying  the  Ordinance  and  Rules  and  Regulation  on  the  Matter. 

DEPARTMENT  OF  THE  INTERIOR, 

MONTEVIDEO,  December  18,  1903. 

In  view  of  this  appeal  against  the  ordinance  and  rules  and  regulations  con- 
cerning inns  and  dairies  issued  by  the  Economic- Administrative  Board  of  Mon- 
tevideo ; 

Inasmuch  as  the  opinion  of  the  Board  of  Health  coincides  with  that  of  the 
aforesaid  Board  concerning  the  efficiency  and  advisability  of  tuberculization ;  and 

Whereas,  agreeing  with  said  Board  of  Health  that  the  sale  of  tuberculous  ani- 
mals should  not  be  allowed,  both  because  they  might  be  improperly  used  in  dairies 
located  outside  of  the  Capital,  and  because  with  the  products  thereof  they  might 

*By  orders  issued  by  the  Economic- Administrative  Board,  under  date  of  May  31  and  July 
a,  1904,  it  was  prescribed  that  if  the  owners  of  animals  to  be  slaughtered,  after  being  duly 
notified,  should  fail  to  attend  to  witness  the  autopsy,  and  to  skin  the  animals,  the  latter 
shall  be  considered  abandoned,  and  the  Bureau  may  order  their  sale  at  public  auction,  the 
skinning  being  at  the  expense  of  the  buyer,  and  the  sale  being  null  and  void  if  from  the 
autopsy  it  should  appear  that  the  carcasses  of  the  animals  must  be  destroyed. 

'Modified  by  executive   decree  of   December    18.    1903. 

•Modified  by  executive  order  of  December  18,   1903. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  22/ 

compete  with  the  inn  or  dairy  keepers  who  have  been  compelled  to  dispose  of 
said  animals. 

In  case  it  should  be  proved  that  the  animal  has  tuberculosis,  it  would  not  be 
just  to  compel  the  municipality  to  pay  the  full  value  of  the  animal,  but  the  loss 
should  be  sustained  mainly  by  the  owner. 

That,  as  regards  the  animals  classified  as  suspected,  the  remarks  of  the  Board 
concerning  the  inconvenience  of  their  presence,  in  the  fenced  places  of  city 
dairies,  are  worthy  of  consideration,  inasmuch  as  said  presence  favors  the  devel- 
opment of  the  disease,  the  existence  of  which  was  suspected;  but  the  remarks  of 
the  appellants  concerning  the  uselessness  of  branding  said  animals,  since  they 
can  be  identified  by  the  brand  of  the  owner,  and  the  certificate  of  health,  and 
also  concerning  the  damage  said  brand  causes  them  whenever  it  has  not  already 
been  confirmed  that  the  animals  are  actually  afflicted  with  tuberculosis,  are  also 
worthy  of  consideration; 

Inasmuch  as  the  municipal  authorities  themselves  recognize  that  the  tariff 
in  force  could  be  modified  without  prejudice  to  the  revenues,  it  is  proper  to  grant 
said  reduction,  since  these  kinds  of  services  should  not  become  a  source  of  reve- 
nue to  the  Government ; 

Now,  therefore,  the  Executive  Power,  exercising  the  authority  vested  in  him 
by  Article  41  of  the  organic  law  relating  to  Boards,  resolves  to  maintain  the 
ordinance  and  rules  and  regulations  from  which  an  appeal  has  been  made,  with 
the  following  modifications : 

1.  Such  cows  as  have  been  declared  to  have  tuberculosis,  shall  be  slaugh- 
tered, and  the  Board  shall  pay  to  their  owners  such  value  as  the  cows  may 
have   as   beef  cattle,   deducting  the   amount  received   for   such  portion   of  the 
carcasses  as  is  utilized. 

Indemnization,  as  a  milch  cow,  shall  only  be  proper  whenever  it  should  be 
proved  by  the  autopsy  that  the  diagnosis  was  wrong. 

2.  The  sanitary  inspection  shall  not  be  prolonged  more  than  three  days,  and 
the  maximum  charge  for  the  keep  of  the  cows  in  the  place  of  inspection  shall  be 
50  cents  each. 

3.  The  owners  of  dairies  and  inns  shall  be  entitled  to  dispose  of  healthy 
animals  without  any  other  restriction  than  the  proper  notification  to  the  Inspec- 
tion Bureau,  and  the  certificate  of  health  will  also  be  useful  to  the  purchaser. 

4.  Animals  which  °  are  simply  suspected,  shall  not  be  branded  and  shall  be 
identified  by  the  certificates  of  health  and  the  brands  of  the  proprietor. 

We  should  add  that  the  importation  of  animals  is  subject  to  a  veterinary  in- 
spection at  the  ports  of  the  Republic,  and  that  such  animals  as  are  afflicted  with 
tuberculosis  are  either  rejected  or  slaughtered. 

Before  closing  my  remarks,  I  wish  to  state  that  the  Uruguayan  League  against 
Tuberculosis,  a  private  institution  established  in  1902,  has  played  and  is  playing 
an  important  part  in  the  campaign  against  said  disease,  having  earnestly  en- 
deavored to  prevent  its  development  among  the  poorer  classes.  To  this  end,  said 
Institution  has  established  and  maintains  three  dispensaries  in  Montevideo,  and 
five  in  the  rest  of  the  Republic,  which  are  so  many  other  centers  of  propaganda 
and  distribution  of  the  most  elementary  precautionary  measures,  and  where  the 
sick  find  proper  medical  attendance  and  suitable  food. 

The  pecuniary  means  that  at  the  disposal  of  said  league  derived  from  a 
monthly  subsidy  from  the  National  Committee  of  Public  Charities,  from  private 
donations,  from  fairs  organized  in  behalf  of  said  Institution,  and  from  the 
amounts  paid  by  the  members  thereof,  have  enabled  said  Institution  to  carry  out 
some  of  its  plans,  and  to  extend  into  certain  departments  the  services  which  it 
renders  at  the  Capital  to  such  consumptives  as  seek  its  protection  and  support. 

During  the  year  which  will  soon  end,  it  has  constructed  a  model  dispensary, 
which  is  superior  to  any  of  those  now  existing  in  the  other  Latin- American 
countries. 

Among  the  plans  which  the  League  is  considering,  the  most  important  is  the 
one  relating  to  the  establishment  and  operation  of  new  dispensaries  in  such 
places  in  the  city  where  the  laboring  classes,  which  furnishes  the  most  cases 
of  tuberculosis,  are  most  numerous. 

Dr.  Joa<juin  de  Salterain,  the  learned  President  of  said  Institution,  has  devoted 
his  great  learning,  activity  and  perseverance  to  the  service  of  said  Institution, 
and,  with  the  co-operation  of  his  worthy  companions  of  the  Board  of  Directors, 
continues  his  humanitarian  work,  convinced  that  each  day  collective  effort  be- 


228  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

comes  more  imperative  because  the  disease  in  question  progresses  daily,  and  it 
is  the  duty  of  all  to  prevent  its  development. 

TYPHOID   FEVER. 

Typhoid  fever  is  another  of  the  diseases  which  prevail  in  Uruguay,  and  the 
development  of  which  is  observed  in  certain  months,  that  is  to  say  from  Decem- 
ber to  June  of  each  year,  with  the  peculiarity  that  said  epidemics  some  times 
break  out  before  the  former  month  and  end  after  the  latter. 

The  greater  increase  of  typhoid  fever  in  summer  and  fall,  and  the  disap- 
pearance of  it  in  winter,  is  not  only  true  of  Uruguay  but  also  of  other  countries, 
and  it  would  be  worth  while  to  make  some  investigations  concerning  this  point, 
in  order  to  determine,  if  possible,  to  what  cause  its  periodical  paroxysms  are 
due.  Be  it  as  it  may,  it  is  a  positive  fact  that  typhoid  fever  prevails  in  all  of 
the  departments  of  the  Republic,  though  in  greater  virulence  in  some  than  in 
others. 

The  following  table  shows  the  number  of  deaths  caused  by  typhoid  fever 
during  the  last  ten  years. 

DEATHS. 

1897  to  1906. 

First  five  years.  Second  five  years. 

1897 302                      1902 107 

1898 217                      1903 188 

1899 122                      1904 280 

1900 146                      1905 153 

1901 129                      1906 276 

916  1,067 

Grand  total 1,983 

It  will  be  seen  that  the  number  of  deaths  decreased  up  to  1899;  there  was  a 
slight  increase  in  1906,  and  again  there  was  a  decrease  in  1901. 

During  the  second  five  years,  the  increase  was  notable  up  to  1904;  in  1905 
there  was  a  small  decrease,  while  in  1906  there  was  a  new  increase. 

In  a  word,  we  may  say  that  the  mortality  during  the  second  five  years  was 
greater  than  that  of  the  first  five  years. 

The  measures  adopted  for  combatting  typhoid  fever  are  stated  in  the  follow- 
ing provisions : 

NATIONAL  BOARD  OF  HEALTH. 

General  Rules  for  Preventing  the  Contagion  and  Spread  of  Typhoid  Fever, 
Approved  at  the  Session  of  July  3,  1899. 

I. 

Concerning  the  Epidemic  Development  of  Typhoid  Fever. 

1.  Of  all  epidemic  diseases  prevailing  in  the  Republic,  typhoid  fever  is  the 
one  that  follows  the  most  regular,  periodical  and  annual  course. 

2.  In  the  Department  of  Montevideo  the  months  least  favorable  to  its  spread 
are  August,  September,  October  and  November.    From  the  latter  month,  cases 
of  this  disease  are  more  frequent  until  March  and  April,  and  then  decrease 
gradually  until  August. 

3.  During  the  months  that  it  is  most  prevalent  (March  and  April),  the  rural 
districts  suffer  most  from  its  ravages. 

4.  The  conditions  of  the  development  of  typhoid  fever  in  the  country  are 
not  yet  sufficiently  known,  but  it  is  likely  that  it  follows  there  a  periodical, 
general  and  similar  evolution. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  22Q 

II. 

Elements  of  Contagion  and  Means  of  Propagation. 

5.  The  germs  of  typhoid  fever  are  mainly  found  in  the  excrements  of  patients, 
and  in  certain  stages,  in  the  sputum,  urine  and  pus. 

6.  The  dejections  and  other  vehicles  of  germs,  namely,  the  sputum,  urine 
and  pus,  contaminate  the  skin  of  the  patients,  their  clothes  and  bedclothes,  and 
transmit  it  to  their  attendants  and  to  the  articles  used. 

7.  As  the  germs  of  this  disease  are  not  destroyed  by  the  temperature  of  the 
room,  and  desiccation,  and  as  they  continue  to  live  in  the  open  air,  as  well  as 
without  it,  the  dejections,  the  articles,  the  clothes  and  persons  contaminated 
become  vehicles  of  contagion  and  spread  the  disease  by  the  different  means 
which   favor   the   transmission,   multiplication   or   diffusion   of  the   contagious 
agent,  such  as  water,  soil,  dust,  dung,  etc. 

8.  When  typhoid  fever  forms  foci,  that  is  to  say,  when  repeated  cases  occur 
in  a  zone,  locality  or  house,  it  is  generally  due  to  the  contamination  of  water 
through  the  dejections. 

9.  The  deficient  construction  of  cesspools  and  drains  favor  the  contamination 
of  water  of  springs,  as  well  as  of  wells,  because  of  the  permeability  of  the 
same.    Cisterns,  though  on  a  smaller  scale,  also  render  possible  the  contamina- 
tion of  the  water  they  contain,  since  the  walls  thereof,  as  generally  constructed, 
do  not  constitute  an  invulnerable  barrier  to  the  germs  of  typhoid  fever. 

10.  In  a  place  where  the  water  supply  is  obtained  from  cachimbas,  springs, 
creeks  or  brooks,  a  single  patient  may  be  the  origin  of  a  local  epidemic,  owing 
to  the  liability  of  said  waters  to  become  contaminated  by  the  dejections  of  the 
patient,  which  are  deposited  in  the  neighborhood  without  having  been  previously 
disinfected. 

11.  The  waters  from  rivers  and  brooks,  though  they  become  contaminated 
just  as  easily  as  those  from  springs,  cachimbas,  creeks  and  brooks  do  not  trans- 
mit the  disease  so  easily,  either  owing  to  the  volume  of  water,  to  the  natural 
purification  in  the  long  distance  over  which  the  water  has  to  flow,  or  to  the 
mechanical  and  chemical  means  at  present  used,  as  it  happens,  in  the  flowing 
water  of  Montevideo,  the  fact  is  that  the  presence  of  the  typhoid  germs  has  not 
as  yet  been  detected  in  the  waters  of  our  rivers.    The  investigations  of  the 
kinds  of  water  consumed  in  the  houses  in  which  there  have  been  patients  of 
typhoid  fever,  in  the  department  of  Montevideo,  confirm  this  conclusion. 

III. 
Concerning  Disinfectants. 

12.  The  solutions  recommended  by  the  Board  of  Health  are  the  following :    A 
weak  solution  of  bichloride  of  mercury  in  the  proportion  of  I  per  1,000  for  wash- 
ing the  hands,  which  is  a  colorless  or  slightly  pink  solution  when  the  bichloride 
capsules  are  used. 

A  strong  solution  of  bichloride  of  mercury  in  the  proportion  of  2  per  1,000 
for  bedclothes,  the  cleaning  of  the  furniture,  floors,  etc. 

A  solution  of  sulphate  of  copper  in  the  proportion  of  5  per  cent  (greenish), 
to  disinfect  the  dejections  and  other  matter  expelled  by  the  patient. 

13.  The  vessels  containing  the  solutions  of  bichloride  as  well  as  those  of 
sulphate  of  copper  should  be  of  glass,  porcelain,  earthenware,  enameled  iron  or 
wood.    The  receptacles  of  copper,  iron,  tin  and  zinc  are  destroyed  by  the  bichlo- 
ride, and  only  those  of  copper  will  resist  the  action  of  the  sulphate. 

14.  In  order  to  prepare  the  first  two  solutions,  the  most  practical  way  is  to 
employ  the  capsules  of  bichloride  of  mercury,  each  of  which  contains  one  gram 
of  the  active  substance. 

One  of  these  shall  be  dissolved  in  a  liter  of  water  for  the  weak  solution,  and 
a  for  the  strong  solution. 

15.  When  the  disinfection  is  made  officially  in  order  to  prepare  the  weak 
solution,  it  will  be  sufficient  to  mix  the  quantity  delivered  by  the  disinfecting 
officials  with  an  equal  quantity  of  water. 

16.  As  the  aforesaid  solutions  are  poisonous,  the  disinfection  of  the  utensils 
employed  for  taking  food  and  the  administration  of  medicines  should  be  done 
with  boiling  water. 


230  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

IV. 

Precautions  to  Prevent  Persons  Having  Typhoid  Fever  From  Transmitting  or 

Spreading  the  Disease. 

17.  The  patients  shall  be  isolated  during  the  entire  course  of  the  disease. 

18.  The  beds  shall  be  placed  in  the  center  of  the  room. 

19.  All  the  furniture  of  the  room,  except  that  which  is  indispensable,  shall  be 
removed  and  disinfected,  as  well  as  the  carpets,  curtains,  etc. 

20.  If   the   patient   occupies   a   room   containing  much   furniture   and   other 
articles,  and  another  room  is  provided  to  be  occupied  by  the  patient,  the  room 
having  the  best  conditions  for  isolation  and  light  should  be  selected  and  should 
be  previously  prepared  for  the  reception  of  the  patient,  leaving  therein  only 
the  furniture  absolutely  necessary. 

21.  After  the  transfer  of  the  patient  has  been  effected,  the  first  room  occupied 
by  him  shall  be  thoroughly  disinfected,  just  as  in  the  case  of  a  final  disinfection, 
and  the  latter  as  well  as  the  former  shall  always  be  made  officially  in  the  Depart- 
ment of  Montevideo. 

22.  Special  care  should  be  taken  that  the  chambers  used  during  the  night,  and 
other  receptacles  in  which  the  matter  thrown  off  by  the  patient  are  collected, 
Shall  always  contain  a  green  solution  of  sulphate  of  copper  in  the  proportion  of 
5%,  and  in  a  sufficient  quantity  so  that  it  may  entirely  cover  the  matter  thrown 
off  by  the  patient,  and  this  solution  shall  be  renewed  as  many  times  as  may  be 
necessary. 

23.  All  clothes  or  articles  removed  from  the  room  of  the  patient  shall  be 
previously  disinfected  with  a  strong  solution  of  bichloride  of  mercury,  or  with 
boiling  water,  as  the  case  may  be,  and  this  should  be  especially  done  to  the 
clothes  sent  to  be  washed. 

24.  The  cleaning  of  the  room  shall  be  effected  with  rags  soaked  in  a  strong 
disinfecting  solution,  without  sweeping  the  floor  nor  using  the  duster  in  order  to 
remove  the  dust  from  the  furniture. 

25.  The  patients  shall  be  kept  thoroughly  clean  and  his  clothes,  as  well  as  the 
bedclothes,  should  be  changed  frequently. 

26.  The  room  should  be  frequently  ventilated. 

27.  When  the  disease  has  run  its  course  and  the  attending  physicians  think 
proper  to  suspend  the  isolation  of  the  patient,  the  final  disinfection  shall  be 
done  officially. 

V. 

Precautions  for  the  Purpose  of  Preventing  Healthy  Persons  From  Contracting 
or  Transmitting  the  Contagion. 

28.  Only  such  contact  with  the  patient  as  is  absolutely  necessary  for  his  proper 
attendance,  should  be  had. 

29.  Only  the  persons  necessary  to  attend  him  shall  be  allowed  to  enter  or 
remain  in  his  room. 

30.  The  patient  shall  be  attended  by  as  few  persons  as  possible. 

31.  It  would  be  advisable  for  the  persons  attending  the  patient  to  use  an  apron 
or,  preferably,  a  blouse,  in  order  to  protect  their  clothes,  and  such  clothes  as 
have  been  used  shall  be  disinfected  with  the  strong  solution  already  referred  to. 

32.  The  hands  shall  be  washed  each  time  contact  is  had  with  the  patient  or 
with  the  contaminated  articles,  immersing  the  hands  in  the  weak  solution. 

33.  The  attendants  shall  neither  eat  nor  drink  in  the  room  of  the  patient. 

34.  The  persons  attending  the  patient  shall,  before  leaving  the  room,  remove 
their  aprons  or  blouses,  wash  and  disinfect  their  hands  with  the  weak  solution, 
and  rub  the  sole  of  their  shoes  on  a  rag  soaked  in  the  strong  solution. 

35.  The  persons  attending  the  patient  shall  avoid  having  any  contact  with 
healthy  persons  before  changing  their  clothes. 

36.  The  clothes  removed  shall  be  ventilated  and  exposed  to  the  sun  for  some 
time. 

37.  The  inmates  of  houses  in  which  there  are  persons  afflicted  with  typhoid 
fever,  and  those  living  in  the  neighborhood,  should  boil  their  drinking  water 
when  it  is  obtained  from  a  cistern,  well,  or  spring,  and  especially  when  there 
arc  other  cases  of  typhoid  fever  in  the  vicinity. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  23! 

VI. 

Precautionary  Measures  Which  Should  be  Taken  in  Schools,  Barracks,  Jails 

Workshops,  Etc. 

38.  Crowding  in  schools,  barracks,  jails,  workshops,  and  generally  in  every 
building  where  persons  gather  in  large  numbers,  shall  be  avoided,  and  the  air 
shall  be  renewed  in  such  places  as  are  occupied,  completely  ventilating  said  places 
when  circumstances  permit. 

39.  Water-closets  should  operate  regularly  and  be  kept  strictly  clean,  and  shall 
be  disinfected  during  the  months  of  December  to  May,  using  for  that  purpose 
the  solution  of  sulphate  of  copper  in  the  proportion  of  5%. 

40.  The  water  for  drinking  purposes  should  be  frequently  inspected  at  schools, 
barracks,  and  rural  camps,  and  when  the  weather  permits,  cisterns  shall  be  thor- 
oughly cleaned  and  the  necessary  repairs  made,  observing  if  there  are  any  filtra- 
tions,  in  which  case  the  water  for  drinking  purposes  should  be  boiled.' 

Precautionary  Measures  in   Camps. 

41.  The  places  used  by  troops  when  in  camps  for  depositing  the  offal  of  their 
persons  shall  be  located  at  a  height  on  an  opposite  or  different  slope  to  the  place 
where  the  drinking  water  supply  is  obtained. 

42.  No  pits  shall  be  dug  for  the  excrements,  but  a  ditch  shall  be  opened  daily 
which  shall  be  narrow  and  shallow,  and  the  contents  shall  be  disinfected  with  the 
aforesaid  strong  solution  of  sulphate  of  copper,  and  the  ditch  used  shall  be 
covered  again  with  the  same  earth  excavated  therefrom. 

43.  The  place  selected  for  washing  the  clothes  should  be  below  the  streams 
from  which  the  water  supply  is  taken. 

44.  Should  any  typhoid  fever  case  occur  among  the  soldiers  encamped,  the 
drinking  water  shall  be  boiled  while  the  troops  remain,  or  until  a  reasonable 
period  of  time  shall  elapse,  which  shall  be  extended,  more  or  less,  according  to 
whether  the  season  is  favorable  or  unfavorable  to  the  spread  of  the  disease. 

45.  This  last  interval  shall  be  used  to  open  new  wells,  to  empty  the  old  ones 
and  disinfect  them  by  whitewashing,  using  at  the  same  time  a  process  of  disin- 
fection  for  the  hogsheads  or  barrels  containing  the  drinking  water. 

VIII. 
Measures  of  a  General  Character. 

In  the  season  in  which  typhoid  fever  usually  develops,  the  Economic-Adminis- 
trative Board  and  Auxiliary  Committees  shall  double  the  viligance  they  exercise 
as  to  the  places  where  dung  piles,  pits,  springs  and  cisterns  are  located  ordering 
the  necessary  repairs  to  be  made  so  that  they  may  properly  operate,  and  be  kept 
entirely  clean. 

47.  The  interior  of  inns  or  dairies,  stables,  tenements,  etc.  shall  be  white- 
washed, complying  with  the  rules  prescribed  regarding  the  number  of  inhabitants 
and  the  ventilation  of  the  rooms. 

48.  The  conditions  under  which  clothes   are  washed  shall  be  subjected  to 
close  inspection,  and  the  proper  instructions  shall  be  given  in  order  that  said 
washing  be  done  down  stream,  far  away  from  the  places  from  which  drinking 
water  is  obtained. 

49.  Excrements  shall  not  be  allowed  to  be  thrown  on  the  slopes  of  water 
sheds  from  which  the  water  supply  of  the  town  is  taken,  and  for  that  purpose 
high  places  distant  from  habitations  shall  be  selectedr 

SMALLPOX. 

This  disease,  which  formerly  caused  many  victims  both  in  the  Department  of 
Montevideo  and  the  rural  departments,  and  which  for  some  time  has  prevailed 
in  certain  places  in  an  endemic  or  sporadic  form,  having  occasionally  caused 
more  or  less  important  epidemics,  in  1897  commenced  to  decrease,  and  had  al- 
most been  eliminated  in  1898,  1899  and  1900,  but  in  1901  it  was  imported  again 
and  spread  in  an  epidemic  form  until  the  first  months  of  1903. 


232  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Since  that  time,  the  number  of  deaths  began  to  decrease  considerably,  but 
commenced  to  increase  again  in  1905,  having  decreased  in  1906,  the  figures  con- 
cerning the  mortality  in  the  ten  years  from  1897  to  1906,  give  an  exact  account 
of  the  decrease  of  smallpox. 

DEATHS. 

1897  to  1906. 

First  five  years.  Second  five  years. 

1897 100  1902 244 

1808- 2  1903 5 

1899 3  1904 26 

1900 I  1905 146 

1901 158  1906 9 


The  increase  of  deaths  caused  by  said  disease  in  1904  and  1905  is  easily  ac- 
counted for,  because  in  those  two  years  smallpox  was  imported  again,  and  caused 
a  small  epidemic  which  broke  out  in  Montevideo  and  extended  into  some  rural 
departments.  After  this  epidemic  the  cases  of  smallpox  have  diminished  consid- 
erably and  it  would  not  be  difficult  to  eliminate  the  disease  entirely,  since  the 
sanitary  authorities  are  endeavoring  to  enforce  the  measures  adopted  to  combat 
said  disease. 

Notwithstanding  the  fact  that  there  are  only  two  provisions  which  render 
vaccination  compulsory,  the  fact  is  that  at  present  the  former  difficulties  which 
were  encountered  in  putting  this  preventative  measure  in  force,  do  not  now 
obtain.  For  this  reason  the  number  of  persons  vaccinated  is  daily  increasing,  so 
that  every  year  a  great  number  of  persons  become  immune  in  the  capital  as 
well  as  in  the  country. 

The  provisions  concerning  compulsory  vaccination  to  which  we  have  referred, 
are  the  following: 

Those  of  the  general  rules  and  regulations  of  the  public  schools  of  the  State, 
which  prescribe  that  children  in  order  to  be  admitted  to  said  schools,  must  have 
been  previously  vaccinated,  and  the  rules  and  regulations  concerning  tenement 
houses,  which  read  as  follows: 

"The  manager  of  a  tenement  house  shall  not  hereafter  admit  as  tenant  any 
person  who  has  not  been  previously  vaccinated,  and  shall  forward  a  detailed 
statement  to  the  Board  of  Health  specifying  the  number  of  tenants  who  have 
not  yet  been  vaccinated,  or  who  were  vaccinated  ten  years  ago,  in  order  that 
said  Board  of  Health  may  take  such  measures  as  it  may  deem  advisable,  so 
that  all  such  tenants  may  have  the  benefit  of  vaccination." 

On  the  other  hand,  it  has  been  prescribed  that  persons  who  enlist  in  the  army, 
the  police  force,  persons  entering  jails  and  those  who  are  admitted  into  asylums, 
shall  be  vaccinated. 

To  prevent  smallpox  from  being  imported  through  maritime  ports,  the  follow- 
ing ordinance  concerning  vaccination  and  re-vaccination  of  steerage  passengers 
has  been  decreed: 

NATIONAL  BOARD  OF  HEALTH. 
Ordinance  107. 

MONTEVIDEO,  June  25,  1902. 

Whereas  smallpox  is  a  contagious  disease  which  can  be  imported  through 
maritime  ports; 

Whereas  the  sanitary  authorities  of  the  Republic  have  on  several  occasions 
been  able  to  prove  the  importation  of  said  disease  by  persons  who  have  landed 
from  vessels  coming  from  abroad ; 

Whereas  vaccination  and  re-vaccination  should  be  adopted  as  prophylactic 
measures  in  order  to  avoid,  as  far  as  possible,  the  introduction  of  said  disease ; 

Now,  therefore,  the  National  Board  of  Health,  duly  authorized,  resolves : 

Article  I.  It  shall  be  the  duty  of  the  sanitary  officers,  or  those  on  duty  at 
the  lazaretto,  as  the  case  may  be,  to  require  the  captains  of  steamers  coming  from 
abroad  to  furnish  a  bill  of  health  issued  by  the  proper  sanitary  authority  of  the 
port  of  departure  as  well  as  of  those  where  the  steamer  touched,  countersigned 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  233 

by  the  Uruguayan  consul,  stating  the  number  of  steerage  passengers  vaccinated 
or  re-vaccinated  before  embarking. 

Art.  2.  In  case  the  vaccination  or  re-vaccination  is  effected  during  the  voyage, 
the  captains  of  the  vessels  shall  so  declare  in  writing,  and  shall  sign  said  decla- 
ration together  with  the  physician  on  board,  delivering  the  same  to  the  health 
officer  at  the  port  of  arrival,  with  a  list  of  the  persons  vaccinated  or  re-vaccinated. 

Art.  3.  The  provisions  of  Article  I  shall  govern  even  though  smallpox  does 
not  prevail  at  the  port  of  departure,  or  in  those  where  the  steamer  touched, 
even  though  no  cases  of  smallpox  have  occurred  during  the  voyage. 

Art.  4.  After  the  visit  or  call  of  the  health  officer,  all  steerage  passengers  who 
are  to  land  in  Montevideo,  shall  be  vaccinated  and  re-vaccinated,  inasmuch  as 
they  are  not  comprised  in  the  provisions  of  Articles  I  and  2. 

Art.  5.  Passengers  who  are  going  to  land  at  other  ports,  and  who  want  to 
stop  in  Montevideo,  can  do  so  provided  they  are  comprised  in  the  provisions  of 
Articles  i,  2  and  3. 

Art.  6.  No  steerage  passenger  shall  be  allowed  to  land  unless  he  produces  a 
certificate  of  vaccination,  or  allows  himself  to  be  vaccinated.  If  persons  not 
vaccinated  should  land,  the  captains  will  be  held  responsible. 

Art.  7.  Such  steamers  as  have  had  cases  of  smallpox  on  board,  or  still  have 
them  at  the  time  of  their  arrival  at  the  port,  shall  be  subject  to  the  measures 
specified  in  ordinance  Number  27  of  September  7,  1899. 

Art.  8.  Whenever  the  Board  of  Health  shall  deem  it  necessary,  the  vaccina- 
tion and  re-vaccination  may  be  applied  to  passengers  coming  from  the  Argen- 
tine Republic,  Paraguay  or  Matto  Grosso. 

Art.  9.  This  ordinance  shall  become  effective  as  to  vessels  arriving  after 
September  25. 

In  case  of  vessels  having  smallpox  on  board,  that  is  to  say  vessels  which  upon 
arriving  at  the  port,  or  during  the  time  they  remain  there,  have  one  or  more 
patients  or  convalescents  on  board,  the  following  treatment  shall  be  prescribed : 

(a)  The   landing  of  patients   or  convalescents   in  the   lazaretto,   whenever 
smallpox  does  not  prevail  in  the  city\ 

In  the  contrary  case  they  may  land  in  the  port  and  be  conveyed  to  their  homes 
or  to  the  house  of  isolation,  according  to  circumstances2. 

(b)  The  vaccination  of  passengers  going  to  Montevideo. 

(c)  Sanitary  inspection  on  land. 

In  addition  to  said  maritime  sanitary  measures,  the  National  Board  of  Health 
has  put  in  force  the  following  prophylactic  provisions : 

NATIONAL  BOARD  OF  HEALTH. 

General  Rules  to  Prevent  Contagion  and  Spread  of  Smallpox,  Approved  at  the 
Session  of  September  26,  1908. 

I. 

Concerning  Vaccine  and  Vaccination. 

1.  Vaccination  is  the  only  known  means  for  the  efficient  prevention  of  small- 
pox. 

2.  The  preventative  effects  of  vaccination  are  temporary,  and  it  may  be  said 
that  they  last  not  more  than  ten  years.    After  ten  years,  to  maintain  the  effects 
of  vaccination,  re-vaccination  is  necessary. 

3.  Vaccination  should  be  administered  in  infancy,  and  it  should  be  added  that 
smallpox  is  generally  fatal  among  the  aged. 

4.  At  all  times,  and  all  ages,  people  who  are  not  immune  through  vaccina- 
tion, should  be  vaccinated.    This  is  an  imperative  necessity  especially  in  times 
of  epidemics. 

Victims  of  smallpox  are  those  who  generally  do  not  avail  themselves  of  the 
benefits  of  vaccination,  as  shown  by  the  practice  of  a  century. 

*It  is  understood  that  smallpox  prevails  in  the  city  whenever  it  shall  have  been  proved 
that  there  are  five  or  more  separate  foci  in  the  city. 

JNo  patient  shall  be  transferred  to  tenement  houses,  or  to  rooms  where  many  people 
live  together. 


234  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

5.  Vaccination  seems  to  have  a  beneficial  influence  on  those  afflicted  with 
whooping-cough,  inasmuch  as  it  modifies  in  a  favorable  manner  the  course  of 
the  disease,  and  therefore  this  effect  of  vaccination  should  be  taken  advantage  of. 

6.  When  persons  suffer  from  skin  diseases  they  should  consult  a  physician 
as  to  the  advisability  of  vaccination. 

7.  In  times  of  epidemics,  there  are  persons  who  fear  vaccination,  erroneously 
believing  that  the  latter  favors  the  development  of  the  disease;  the  contrary  is 
the  case,  as  vaccination  is  the  surest  means  of  avoiding  it. 

Even  in  case  the  vaccinated  person  contracts  smallpox,  which  has  not  been 
entirely  developed  because  it  was  in  the  period  of  incubation,  vaccination  will 
considerably  attenuate  its  effects. 

8.  It  frequently  happens  that  young  children,  and  even  older  persons,  con- 
tract a  disease  commonly  known   as  chickenpox,  which  is  erroneously  taken 
for  smallpox,  and  then  they  neglect  subsequent  vaccination  owing  to  this  lament- 
able mistake.    The  disease  in  question  is  called  varicella,  a  disease  quite  similar 
to  smallpox,  but  the  origin  of  which  is  entirely  different,  and  does  not  in  any 
way  protect  against  smallpox,  and  therefore,  vaccination  should  not  be  neglected 
on  account  of  it. 

9.  Vaccination  does  not  exercise  any  harmful  influence  on  the  health  of  the 
vaccinated. 

10.  The  best  vaccine  is  that  obtained  from  heifers,  such  as  that  prepared 
and  distributed  by  the  Municipal  Conservatory  of  Montevideo,  and  used  by  the 
Superior  Board  of  Health  of  the  Republic,  in  all  its  branch  offices1. 

u.     Persons  are  also  vaccinated  from  the  vaccine  taken  from  other  persons, 
but  this  is  a  dangerous  practice  which  should  be  abandoned,  because  certain  dis 
eases  may  be  transmitted  by  the  use  of  such  vaccine. 

12.  The  animal  vaccine  obtained  under  the  conditions  accepted  by  the  Con- 
servatory of  Vaccine  cannot  transmit  any  disease  from  the  animal,  since  the 
latter  is  carefully  examined  while  alive,  and  after  it  is  killed  in  order  to  collect 
the  vaccine. 

13.  Persons  who  have  been  afflicted  with  smallpox,  lose,  like  those  who  have 
been  vaccinated,  their  immunity  after  ten  years,  and  it  is  quite  necessary  for 
both  classes  to  be  vaccinated  periodically. 

II. 

Concerning  Smallpox  Epidemics. 

14.  Smallpox  is  a  very  contagious  disease,  and  is  developed  epidemically  and 
periodically  in  localities  where  there  are  many  people  who  are  not  yet  vaccinated 
or  who  have  not  been  revaccinated. 

15.  The  only  sure  means  to  prevent  or  check  smallpox  epidemics  is  vaccina- 
tion and  revaccination. 

16.  The  isolation  of  patients  powerfully  contributes  to  diminish  the  spread 
of  smallpox,  and  renders  possible  to  check  the  course  of  an  epidemic  in  its 
early  stages,  and  gives  time  to  vaccinate  and  revaccinate  persons  who  are  liable 
to  contract  the  disease. 

17.  The  longer  fhe  time  elapsing  from  a  smallpox  epidemic,  the  greater  the 
probabilities  of  its  appearance  and  rapid  spread. 

TIL 
Conditions  Favorable  to  Contracting  the  Contagion. 

18.  The  following  are  predisposed  to  contract  the  contagion: 

1.  Those  who  have  not  been  vaccinated  or  revaccinated. 

2.  Those  who  attend  the  patients  or  who  are  in  contact  with  them. 

JThe  Conservatory  of  vaccine,  and  the  Bureau  of  Sanitary  Inspection,  at  Montevideo,  the 
Departmental  Boards,  and  the  Sectional  Boards  of  Health  in  the  country,  are  the  Bureaus 
charged  with  the  distribution  of  vaccine. 

Persons  vaccinated  in  said  office  should  report  to  said  office  from  the  fifth  to  the  eighth 
day,  in  order  to  verify  the  results  of  vaccination. 

The  Municipal  Board  of  Health  furnishes  free  the  services  of  the  physicians  who 
vaccinates,  in  homes  where  there  are  smallpox  or  varioloid  patients. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  235 

3.  Those  touching  the  clothes  or  articles  belonging  to  the  patients  or 

to  their  rooms. 

4.  Those  who  are  in  contact  with  the  persons  who  attend  the  patients, 

or  who  have  been  in  contact  with  them. 

5.  Those  living  in  the  same  house. 

6.  Neighbors. 

19.  Vaccination,  the  isolation  of  the  patients  and  a  careful  and  thorough  dis- 
infection, observing  the  rules  recommended,  will  avoid  contagion  within  the  scope 
of  the  action  of  each  of  these  measures. 

IV. 
Elements  of  Contagion. 

20.  The  germs  of  smallpox  exist  in  the  eruption,  and  retains  its  life  in  the 
scabs  a  long  time  after  it  has  been  thrown  off  or  separated  from  the  skin. 

21.  Since  the  eruption  invades  the  mouth,  the  nostrils,  and  even  the  bron- 
chial tubes,  and  saliva,  the  nasal  mucus,  and  the  expectoration,  these  also  con- 
tain the  contagious  agent.     Consequently,  in  order  to  prevent  the  spread  and 
contagion  of  smallpox,  it  is  necessary  to  apply  suitable  means  to  destroy  the 
effects  of  all  those  products,  following  for  that  purpose  the  rules  indicated  in 
these  provisions. 

22.  Smallpox  patients  transmit  the  contagion  until  all  the  scabs  have  com- 
pletely fallen  off. 

23.  It  is  during  the  period  of  the  loosening  of  the  scab  that  patients  are  most 
liable  to  transmit  the  contagion. 

24.  Smallpox  is  transmissible  by  the  direct  contact  of  the  patient,  and  also 
through  the  persons  and  articles  which  have  been  contaminated. 

25.  It  is  also  propagated  from  a  distance  through  the  air  which  wafts  the 
contagious  agent  contained  in  the  dust  of  infected  places. 

V. 

Concerning  Disinfectants. 

The  Board  of  Health  recommends  the  use  of  the  following  solutions: 
A  weak  solution  of  bichloride  of  mercury  in  the  proportion  of  i  per  thousand, 
in  which  to  wash  the  hands  and  to  immerse  the  clothes  in  the  early  stages  of 
the  disease. 

A  strong  solution  of  bichloride  of  mercury  in  the  proportion  of  2  per  thousand, 
to  disinfect  the  clothes  during  the  period  of  suppuration,  and  until  the  scabs 
have  entirely  fallen  off,  and  also  for  the  disinfection  of  the  products  of  expec- 
toration, the  cleaning  of  the  floors,  furniture,  contaminated  clothes,  the  vessels 
used  for  collecting  the  expectoration,  and  vomits,  and  the  disinfection  of  the 
utensils  used  in  the  care  of  the  patient,  the  room,  etc. 

27.  In  order  to  prepare  these  solutions,  the  most  practical  way  is  to  employ 
tablets  of  bichloride  of  mercury,  each  of  which  contains  i  gram  of  the  active 
substance. 

One  of  them  should  be  dissolved  in  a  liter  of  water,  in  the  case  of  the  weak 
solution,  and  two,  in  the  case  of  the  strong  solution. 

28.  When  the  disinfection  is  made  officially,  it  shall  be  sufficient,  in  order  to 
prepare  the  weak  solution,  to  mix  with  an  equal  quantity  of  water  that  delivered 
by  the  officers  who  make  the  disinfection. 

VI. 
Precautions  to  Prevent  the  Patients  from  Transmitting  or  Spreading  the  Disease. 

29.  The  patient  should  be  completely  isolated  during  the  entire  course  of  the 
disease,  and  until  he  has  taken  a  bath  or  antiseptic  lotions. 

30.  The  bed  shall  be  placed  in  the  center  of  the  room  in  order  to  prevent 
the  patient  from  expectorating  on  the  walls,  and  also  to  prevent  the  scabs  from 
being  introduced  in  the  socles. 


236  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

31.  All  furniture  not  absolutely  indispensable  shall  be  removed  from  the 
room  and  disinfected,  as  well  as  carpets,  curtains,  etc. 

33.  When  the  patient  has  been  transferred  to  another  place,  the  rooms  shall 
be  thoroughly  disinfected,  as  in  the  case  of  the  final  disinfection,  and  both  dis- 
infections shall  be  made  officially. 

34.  Special  care  shall  be  taken  so  that  the  scabs,  the  products  of  expectora- 
tion, the  nasal  mucus,  and  the  saliva,  be  disinfected  with  a  strong  solution  of 
bichloride  of  mercury  in  the  proportion  of  2  per  thousand.    To  this  end,  porce- 
lain, glass  or  enameled  iron  vessels,  that  do  not  affect  said  solution  nor  are 
deteriorated  by  its  action,  shall  be  used. 

35.  All  articles  removed  from  the  room  shall  be  previously  disinfected  with 
the  weak,  or  strong  solution,  as  circumstances  may  require. 

36.  The   bedclothes,   and   clothes   personally   used   by   the   patient,   shall   be 
immersed  in  a  strong  disinfecting  solution  before  they  are  sent  to  be  washed. 

37.  The  cleaning  of  the  room  shall  be  effected  with  rags  dipped  in  the  strong 
disinfecting  solution,  and  the  floor  shall  not  be  swept  nor  the  furniture  dusted. 

38.  The  patient  shall  be  kept  entirely  clean,  and  his  clothes  as  well  as  the 
bedclothes  should  frequently  be  changed. 

39.  The  rooms  shall  be  frequently  ventilated. 

40.  On  the  disappearance  of  the  disease,  and  when  the  attending  physician 
should  deem  proper  to  suspend  the  isolation  of  the  patient,  the  final  disinfection 
shall  be  officially  made. 

VII. 

Precautions  to   be   Taken  to  Prevent  Healthy  Persons  From  Contracting  or 
Transmitting  the  Contagion. 

41.  No  more  contact  should  be  had  with  the  patient  than  is  absolutely  neces- 
sary for  his  attendance. 

42.  Only  the  persons  necessary  to  attend  the  patient  shall  enter  his  room  or 
remain  there. 

43.  The  patient  should  be  attended  by  as  few  persons  as  possible,  and  they 
must  have  been  vaccinated,'  or  revaccinated  when  ten  years  have  elapsed  since 
their  first  vaccination. 

44.  Only  the  attendants  shall  be  allowed  to  enter  the  room. 

Persons  who  attend  the  patient  should  wear  an  apron,  or,  preferably,  a  blouse, 
in  order  to  protect  their  clothes,  said  apparel  shall  be  changed  often,  and  those 
which  have  been  used  shall  be  disinfected  with  the  strong  solution  already 
mentioned. 

46.  The  nurses  shall  wash  their  hands  each  time  they  come  in  contact  with 
the  patient,  or  with  the  contaminated  articles,  first  with  soap  and  then  with  the 
weak  solution. 

47.  Eating  or  drinking  in  the  room  of  the  patient  should  be  prohibited. 

48.  Before  leaving  the  room  the  nurses  shall  remove  their  aprons  or  blouses, 
brush  their  clothes  with  a  brush  wet  in  the  strong  solution,  wash  and  disinfect 
their  hands  with  the  weak  solution,  and  rub  the  soles  of  their  shoes  on  a  rag 
soaked  in  the  strong  solution. 

49.  Persons  attending  the  patient  shall  avoid  putting  themselves  in  contact 
with  healthy  persons  until  they  have  changed  their  clothes. 

The  clothes  which  have  been  changed  and  disinfected  shall  be  properly  venti- 
lated and  exposed  to  the  sun  for  some  time. 

50.  Persons  who  have  not  been  vaccinated,  or  who  have  not  been  vaccinated 
for  ten  years,  should  not  be  allowed  to  call  or  visit  houses  occupied  by  small- 
pox patients. 

VIII. 

Precautionary  Measures  Adopted  in  the  Schools,  Barracks,  Jails,  Workshops, 

Etc. 

51.  At  times  when  there  is  no  smallpox,  or  when  it  is  of  infrequent  occur- 
rence, greater  attention  should  be  given  to  the  means  employed  to  avoid  an 
epidemic  by  means  of  vaccination,  because  ^  during  epidemics  vaccination  only 
benefits  the  persons  who  submit  to  vaccination. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  237 

52.  Children  should  not  be  admitted  to  schools  who  have  not  been  vaccinated 
or  revaccinated. 

53.  To  be  admitted  to  a  school,  children  under  ten  years  of  age  must  have 
a  certificate  of  vaccination,  and  those  over  that  age  a  certificate  of  revaccinatipn. 

54.  Valid  certificates  are  those  issued  by  physicians,  the  health  authorities,, 
and  the  municipal  authorities. 

55.  -In  the  barracks,  war  vessels,  quartermasters'  offices,  etc.,  the  newly  en- 
listed men  should  be  vaccinated  immediately  after  enlisting.    In  this  manner  the 
breaking  out  of  smallpox  among  the  troops  will  be  avoided,  as  well  as  the  ren- 
dering unfit  for  service  of  a  large  number  of  men  at  a  given  moment,  should 
they  all  be  vaccinated  at  one  time.    The  same  course  shall  be  followed  in  work- 
shops. 

56.  All  persons  admitted  to  poorhouses,  insane  asylums,  correctional  prisons 
and  penitentiaries,  and,  in  general,  to  every  establishment  where  the  stay  of  the 
inmate  is  not  temporary,  shall  be  vaccinated  as  they  are  admitted. 

GABRIEL  HONORE,  JOAQUIN  CANABAL, 

Secretary.  Chairman. 

SCARLET  FEVER. 

Scarlet  fever  is  one  of  those  diseases  that  almost  always  has  preserved  its 
sporadic  nature.  However,  on  certain  occasions,  it  has  developed  epidemically 
in  Montevideo  and  in  some  of  the  rural  departments. 

It  may  be  said  that  in  the  first  six  years  of  the  last  decennial,  only  isolated 
cases  occurred,  a  circumstance  which  will  account  for  the  great  difference  noted 
between  the  mortality  of  that  period  and  that  of  1903,  1904,  and  1905,  during 
which  the  disease  was  at  height.  Lately,  in- 1906,  it  commenced  to  decrease,  and 
the  number  of  deaths  was  reduced  to  twenty-five.  ^ 

In  spite  of  the  aforesaid  increase  of  the  epidemic,  which  could  be  compared 
to  that  which  occurred  from  1894  to  1896,  the  fact  is  that  scarlet  fever  has  not 
eclipsed,  in  the  last  few  years,  the  list  of  mortality  from  contagious  diseases,  by 
the  number  of  deaths  it  has  caused,  as  shown  by  the  following  figures : 

DEATHS. 

1897  to  1906. 

First  five  years.  Second  five  years. 

1897 2                      1902 3 

1898 o                     1903 75 

1899 i                      1904 373 

1900 o                      1905 79 

1901 I                      1906 25 


Grand  total 559 


This  disease  is  subject  to  the  sanitary  provision  governing  the  other  con- 
tagious diseases,  such  as  the  compulsory  report  of  the  cases  which  occur,  the 
isolation  of  the  patient  in  accordance  with  the  provisions  of  the  rules  and  regu- 
lations of  sanitation  on  land,  and  the  disinfection  of  the  rooms  occupied  by  the 
patient,  as  well  as  that  of  their  clothes  and  other  articles  supposed  to  be  con- 
taminated. 

DIPHTHERIA. 

This  endemic  disease,  which  used  to  develop  epidemically  in  a  threatening 
form,  is  one  of  those  which  has  beep  most  easily  checked,  and  with  the  measures 
employed  the  mortality  has  decreased  considerably. 

The  satisfactory  results  obtained  by  limiting  considerably  its  development, 
shows  clearly  the  beneficial  influence  of  the  sanitary  measures  adopted,  and  it 
shows  at  the  same  time  that  said  measures  are  more  efficient  than  is  generally 

The  following  table  shows  the  mortality  during  the  last  ten  years: 


238  THIRD  INTERNATIONAL  SANITARY  CONVENTION 

DEATHS. 

1897  to  1906. 

First  five  years.  Second  five  years. 

1897 144  1902 24 

1898 94  1903 42 

1899 S3  1904 89 

1900 48  1905 76 

1901 50  1906 49 


389  280 

Grand  total 669 


contain  the  provisions  prescribed  to  pre- 
vent the  contagion  and  spread  of  diphtheria  • 


The  following  rules  and  regulations  cc 
jnt  the  contagion  and  spread  of  diphth* 

NATIONAL  BOARD  OF  HEALTH. 


General  Rules  for  Preventing  the  Contagion  and  Spread  of  Diphtheria,    Ap- 
proved at  the  Session  of  May  26,  1898. 

I. 

General  Remarks. 

1.  Diphtheria  is  a  contagious  disease  characterized  by  the  formation  of  mem- 
branes which  can  be  developed  in  the  mucous  membranes  exposed  to  the  air, 
namely,  the  eyes,  mouth,  nose,  etc.,  and  in  wounds,  scratches  and  ulcerations 
of  the  skin. 

2.  The  most  frequent  seat  of  the  disease  is  the  throat,  and  then  it  is  called 
diphtheria  pharyngitis,  or  simply  diphtheria. 

From  the  throat  diphtheria  may  extend  or  spread  to  the  nose,  the  larynx 
and  the  bronchial  tubes,  which  often  happens.  When  the  disease  attacks  only 
the  larynx,  or  when  it  extends  to  the  same,  it  is  called  croup. 

Therefore,  croup  and  diphtheria  are  two  different  names  of  the  same  disease. 

3.  The  germ  of  diphtheria  is  found  in  the  membrane  whatever  may  be  the 
seat  of  the  disease.     When  diphtheria  invades  the  throat,  the  nose  or  larynx, 
the  products  of  expectoration,  the  saliva,  and  the  mucus  from  the  nose  constitute 
vehicles,  par  excellence,  for  the   spread   of  the   contagion,   and  therefore,  the 
greatest  care  should  be  taken  to  destroy  the  germs  which  said  products  contain. 

After  the  disappearance  of  the  membrane,  the  germs  continue  to  live  in  the 
mouth  of  the  convalescents  for  a  longer  or  shorter  period  of  time,  and  conse- 
quently may  be  a  cause  of  danger  to  all. 

II. 
Conditions  Favorable  to   the  Contagion. 

4.  Diphtheria  occurs  more  frequently  among  children,  but  can  be  contracted 
at  all  ages. 

5.  Persons  having  very  large  or  inflamed  tonsils,  are  predisposed  to  the  con- 
tagion. 

Children  often  afflicted  with  sore  throat  should  receive  special  attention. 

III. 

Concerning   the   Treatment. 

6.  The  anti-diphtheric  serum  is  the  most  efficient  treatment  for  combatting 
diphtheria. 

7.  The  serum  prepared  by  the  institute  of  experimental  hygiene,  possesses 
all  the  qualities  required. 

8.  The  treatment  by  means  of  the  injections  of  the  anti-diphtheric  serum,  is 
the  more  efficient  the  sooner  it  is  applied,  and  saves  the  life  of  a  great  many 
patients  when 'used  immediately  after  the  disease  is  developed. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  239 

9.  The  injections  of  the  serum  serve  to  prevent  contracting  the  disease,  and 
should  be  administered  to  the  children  who  remain  in  the  foci  of  the  epidemic 
where  they  can  not  avoid  the  contact  of  the  patient  or  the  persons  attending 
them.1 

IV. 

Disinfectants. 

10.  The  Board  of  Health  recommends  the  use  of  the  following  solution: 

A  weak  solution  of  bichloride  of  mercury,  in  the  proportion  of  I  per  1000  for 
washing  the  hands,  and  in  which  to  immerse  clean  or  partially  contaminated 
clothes. 

A  strong  solution  of  bichloride  of  mercury,  in  the  proportion  of  2  per  thou- 
sand for  disinfecting  the  products  of  expectoration,  for  cleaning  the  floors,  fur- 
niture, the  contaminated  clothes,  the  vessels  used  for  collecting  the  products  of 
expectoration,  and  the  vomit,  and  also  the  disinfection  of  utensils  employed  in 
attending  the  patient,  etc. 

11.  The  best  practical  means  of  preparing  these  solutions  is  to  use  tablets  of 
bichloride  of  mercury,  which  contain  i  gram  each  of  the  active  substance. 

One  tablet  shall  be  dissolved  in  a  liter  of  water  in  the  case  of  the  weak  solu- 
tion, and  two  in  the  case  of  the  strong  solution. 

V. 

Precautions  to  be  Taken  to  Prevent  Patients  From  Transmitting  or  Spreading 

the  Disease. 

12.  The  patient  shall  be  entirely  isolated  during  the  course  of  the  disease, 
and  shall  be  kept  in  comparative  isolation  for  a  period  of  four  weeks  after 
being  pronounced  cured. 

13.  The  bed  of  the  patient  shall  be  placed  in  the  center  of  the  room  to  pre- 
vent him  from  expectorating  on  the  walls.    These  provisions  will  permit  the 
persons  attending  the  patient  to  move  freely  in  the  room. 

14.  All  the  furniture  of  the  room,  except  that  which  is  absolutely  necessary 
shall  be  removed  and  disinfected,  as  well  as  the  carpets,  curtains,  etc. 

15.  If  the  room  occupied  by  the  patient  contains  much  furniture  and  other 
articles,  and  he  is  transferred  to  another  room,  the  room  having  the  best  con- 
ditions for  isolation  and  light,  shall  be  selected,  and  shall  be  prepared  for  the 
reception  of  the  patient,  keeping  therein  only  such  furniture  as  is  absolutely 
necessary. 

16.  After  the  patient  has  been  transferred,  the  first  room  occupied  by  him 
shall  be  thoroughly  disinfected,  as  in  the  case  of  the  final  disinfection,  and  both 
shall  be  made  officially. 

17.  Special  care  should  be  taken  to  prevent  the  mucous  from  the  nose,  vomits 
and  the  saliva  from  being  thrown  out  of  the  receptacle  containing  a  strong  dis- 
infecting solution  of  bichloride  of  mercury  in  the  proportion  of  2  per  thousand. 
To  this  end  porcelain,  glass,  or  enameled  iron  vessels,  which  do  not  affect  the 
aforesaid  solution,  nor  deteriorate  by  the  action  thereof,  shall  be  used. 

18.  There  shall  be  placed  on  the  bed  of  the  patient  a  piece  of  oilcloth,  or 
rubber  cloth,  to  protect  the  bed,  and  it  shall  be  frequently  disinfected  by  wiping 
it  off  with  a  rag  wet  in  the  strong  disinfecting  solution. 

19.  Everything  removed  from  the  room  of  the  patient  shall  be  previously 
disinfected  with  the  weak  solution,  or  with  boiling  water,  as  may  be  deemed 
advisable. 

20.  The  bedclothes  and  clothes  of  the  patient  shall  be  immersed  in  boiling 
water,  or  in  the  strong  disinfecting  solution,  before  they  are  sent  to  be  washed. 
The  room  shall  be  cleaned  with  rags  soaked  in  the  strong  disinfecting  solution, 
without  sweeping  the  floor  or  dusting  the  furniture. 

22.  The  patient  shall  be  kept  entirely  clean,  and  both  his  clothes  and  the  bed- 
clothes shall  be  changed  frequently. 

23.  The  room  shall  be  frequently  ventilated,  preferably  when  the  rays  of  the 
sun  penetrate  therein. 

1The  anti-diphtheric  serum  prepared  by  the  Health  Institute  will  be  found  in  all  the  drug 
stores  of  the  Republic  in  sufficient  quantities  to  meet  the  first  requirements. 


24O  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

24.  When  the  disease  has  run  its  course  and  the  attending  physician  deems 
proper  to  discontinue  the  strict  isolation  of  the  patient,  the  final  disinfection  shall 
be  officially  made. 

VI. 

Precautions   to   be   Taken   to   Prevent  Healthy  Persons  From  Contracting   or 
Transmitting  the  Contagion. 

25.  No  more  contact  shall  be  had  with  the  patient  than  that  absolutely  neces- 
sary to  attend  him. 

26.  Only  the  persons  necessary  to  attend  him  shall  be  allowed  to  enter  or 
remain  in  his  room. 

27.  Persons  attending  the  patient  shall  wear  an  apron,  or  preferably  a  blouse, 
in  order  to  protect  their  clothes,  and  they  shall  frequently  change  and  disinfect 
those  they  have  used  with  the  aforesaid  strong  solution  or  with  boiling  water. 

28.  The  attendants  shall  wash  their  hands  whenever  they  come  in  contact 
with  the  patient  or  with  contaminated  articles,  first  with  soap  and  afterwards 
with  the  weak  solution  already  mentioned,  and  the  same  shall  be  done  with  the 
face  when  necessary. 

29.  Neither  eating  nor  drinking  shall  be  allowed  in  the  room  of  the  patient. 

30.  Persons  who  attend  the  patient  shall  remove  their  aprons  or  blouses, 
brush  their  clothes  with  a  brush  wet  in  the  strong  solution,  wash  and  disinfect 
their  hands  with  the  weak  solution,  and  rub  the  soles  of  their  shoes  on  a  rag 
soaked  in  the  strong  solution  before  leaving  the  room  of  the  patient. 

31.  The  nurses  shall  avoid  having  any  contact  whatever  with  healthy  chil- 
dren, except  after  having  changed  their  clothes. 

The  clothes  which  have  been  used  and  changed  shall  be  disinfected,  ventilated 
and  exposed  to  the  sun  for  some  time. 

32.  Children  with  large  and  swollen  tonsils  should  not  be  allowed   to   visit 
houses  where  there  are  persons  suffering  with  sore  throat,  nor  should  the  latter 
be  allowed  to  visit  the  houses  of  the  former  until  four  weeks  shall  have  elapsed 
from  the  date  of  their  entire  recovery,  because  there  are  some  mild  forms  of 
diphtheria  the  real  nature  of  which  are  not  easily  detected. 

33.  Children  who  have  been  in  contact  with  diphtheria    patients    shall    be 
closely  watched,  and  their  throats  should  be  examined  at  least  twice  a  day. 

VII. 
Precautionary  Measures  to  be  Taken  in  Schools. 

34.  As  the  proper  authorities,  namely,  the  Board  of  Health  of  Montevideo, 
acquire  such  data  as  are  furnished  by  the  report  blanks,  they  shall  inform  the 
respective   principals   of   the   schools,   as   to   the    registered   children   who    are 
afflicted  with  diphtheria. 

35.  Without  prejudice  to  the  foregoing,  the  addresses  of  the  children  affected 
with  this  or  other  contagious  diseases,  shall  be  published,  and  the  principals  of 
the  schools  shall  take  daily  notice  of  these  reports. 

36.  It  shall  be  the  duty  of  principals  of  schools  to  determine  the  reason  for 
the  absence  of  children  from  school,  and  if  the  non-attendance  is  caused  by 
illness,  to  determine  the  nature  of  the  latter. 

37.  No  child  living  in  the  same  house  with  persons  suffering  from  diphtheria, 
shall  be  admitted  in  the  schools  until  the  final  disinfection  has  taken  place.    If 
the  child  has  been  suffering  from  diphtheria,  it  shall  not  be  again  admitted  until 
four  weeks  shall  have  elapsed  from  the  date  on  which  its  domicile  was  officially 
disinfected. 

38.  The  principals  shall  take  care  to  keep  away  from  the  schools  all  children 
suffering  with  throat  trouble,  and  whenever  the  non-attendance  of  the  children 
is  prolonged  for  that  reason,  they  shall  only  be  admitted  by  each  child  furnishing 
a  certificate  signed  by  the  physician  stating  that  it  has  not  been  ill  with  diph- 
theria. 

39.  During  the  hours  of  recess,  and  after  the  pupils  have  gone  out,  the  class- 
rooms shall  .be  ventilated  by  opening  the  doors  and  windows  thereof. 

40.  The  floors  shall  not  be  swept,  but  the  dust  shall  be  removed  by  means 
of  wet  rags  or  sponges. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  241 

41  The  class  rooms  shall  be  washed  weekly,  followed  by  disinfection  with  a 
solution  of  bichloride  in  the  proportion  of  i  per  thousand. 

42.  Care  should  be  taken  that  the  clothes  of  the  children  are  clean  before  they 
enter  the  class  rooms,  and  they  shall  be  required  to  wash  their  hands  after  recess. 

MEASLES. 

We  shall  make  only  a  few  remarks  concerning  this  disease,  which  is  the  most 
common  of  all  contagious  diseases,  and  also  the  one  which  has  most  frequently 
assumed  an  epidemic  character,  though  of  comparative  mildness. 

The  following  table  shows  the  deaths  caused  by  said  disease  during  the  last 
ten  years : 

DEATHS. 

1897  to  1906. 

First  five  years.  Second  five  years. 

1897 39                      1902 62 

1898. .......      86                      1903 60 

i&)9 40                      1904 3 

1900 37                      1905 14 

1901 58                      1906 97 

260  236 

Grand  total 496 

following  rules  contain  the  provisions  adopted  for  preventing  the  con- 
tagion and  spread  of  said  disease. 

NATIONAL  BOARD  OF  HEALTH. 

General  Rules  for  Preventing  the  Contagion  and  Spread  of  Measles,  Approved 
at  the  Session  of  July  20,  1898. 

GENERAL    REMARKS. 

1.  Measles  is  a  contagious  disease  which  spreads  very  easily. 

2.  It  especially  attacks  children,  though  any  person  may  contract  it,  espe- 
cially if  he  did  not  have  it  during  infancy. 

3.  Measles  is  generally  a  mild  disease,  though  subject  to  serious  complica- 
tions, especially  in  the  case  of  infants,  or  when  there  are  many  patients  of  the 
same  disease  in  the  same  room. 

4.  It  is  transmissible  during  the  entire  course  of  the  disease,  and  especially 
during  the  period  of  its  invasion,  which  precedes,  from   fbur  to  seven  days, 
that  of  the  eruption. 

5.  The  period  of  invasion  sometimes  is  not  detected,  or  the  symptoms  of  the 
disease  are  attributed  to  a  different  malady. 

6.  This  period  is  characterized-  by  a  watering  of  the  eyes,  nasal  catarrh, 
hoarseness,  and  frequent  coughing  or  sneezing,  accompanied  by  a  moderately 
high   fever,   sometimes  quickly   disappearing  and  difficult  to   detect   except   by 
the  use  of  the  thermometer. 

ISOLATION. 

7.  All  persons  having  the  aforesaid  symptoms  shall  be  considered  as  a  sus- 
pected case  of  measles,  and  action  shall  be  taken  in  accordance  with  these  rules. 

8.  Persons  having  the  measles,  or  those  suspected  of  having  said  disease, 
shall  be  isolated  in  rooms  without  decorations  or  ornaments,  and  having  only 
the  necessary  furniture,  and  the  most  indispensable  articles  for  the  attendance 
of  the  patients. 

Well  ventilated  and  lighted  rooms  shall  be  preferred  for  effecting  the  isolation. 

9.  If  the  patient  is  a  nursing  infant,  the  person  nursing  it  shall  avoid  contact 
with  other  children.     In  this  case  it  is  preferable  to  remove  the  healthy  children 
from  the  house  whenever  the  isolation  of  the  patient  has  been  made  from  the 
period  of  the  invasion  of  the  disease,  at  least  four  days  before  the  eruption  has 
appeared. 


242  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

10.  While  a  patient  having  measles  is  in  the  eruptive  period,  healthy  children 
should  not  be  removed  to  other  houses  until  after  a  period  of  twelve  days  shall 
have  elapsed  from  the  last  contact  had  with  the  patient. 

11.  The  isolation  should  be  prolonged  at  least  until  five  days  after  the  erup- 
tion has  entirely  disappeared,  and  admission  of  the  healthy  children  into  the 
room  of  the  patient,  shall  only  be  allowed  after  the  disinfection  and  ventilation 
of  the  contaminated  room  and  clothes. 

12.  Persons  attending  the  patients  shall  have  no  contact  with  other  persons 
until  they  have  disinfected  their  hands,  and  their  outer  clothing. 

13.  In  times  of  epidemics  of  measles,  the  contact  of  children  with  those  of 
other   families   shall  be  prevented,   and  more   especially  of  those   children   in 
whose  houses  there  are  persons  suffering  with  measles,  and  they  should  be  pre- 
vented from  attending  the  places  where  there  is  a  large  number  of  persons. 

Disinfecting  Measures. 

14.  The  disinfectant  which  shall  be  preferably  used  is  a  solution  of  bichloride 
of  mercury  in  the  proportion  of  one  gram  per  liter. 

It  is  easily  prepared  by  dissolving  a  tablet  of  bichloride  containing  the  quan- 
tity above  mentioned  in  a  liter  of  water. 

15.  The  same  solution  shall  be  used  for  disinfecting  the  clothes  and  bed- 
clothes, and  boiling  water  may  also  be  employed  for  the  same  purpose. 

Measures  to  be  Taken  in  Schools. 

16.  Any  child  having  the  symptoms  mentioned  in  paragraph  6,  shall  be  kept 
away  from  school,  and  shall  only  be  admitted  therein  after  five  days  shall  have 
elapsed,  and  when  the  symptoms  which  have  prevented  his  attendance    have 
entirely  disappeared. 

17.  If  during  the  time  the  child  is  away  from  school,  symptoms  of  eruption 
set  in,  and  his  absence  is  prolonged  01^  that  account,  the  child  shall  be  newly 
admitted  only  after  twenty  days  shall  have  elapsed  from  the  date  it  was  denied 
admission  to  the  school,  or  fifteen  days  from  the  date  the  eruption  set  in. 

18.  Should  the  attending  physician  declare  that  the  child  has  the  measles,  the 
child  shall  only  be  admitted  to  school  ten  days  after  the  disinfection  of  the  in- 
fected house  shall  have  been  made. 

19.  After  the  symptoms  which  characterize  the  period  of  invasion  have  been 
confirmed,  or  when  a  pupil,  is  reported  to  have  the  measles,  it  shall  be  the  duty 
of  the  teachers  to  carefully  examine,  at  the  time  of  entering  the  school,  all 
pupils  occupying  seats  adjacent  to  the  pupil  suffering  from  the  measles,  and  the 
teachers  shall  proceed  in  accordance  with  the  provisions  of  paragraph  6,  if  they 
detect  the  aforesaid  symptoms. 

20.  Healthy   children    living  in    houses   where   there   are   persons   with   the 
measles  shall  not  go  to  the  school  until  after  the  pupils  have  left  the  same. 

21.  The  class  rooms  shall  be  ventilated  by  opening  the  doors  and  windows 
thereof. 

22.  The  floors  shall  not  be  swept;  the  dust  shall  be  removed  with  a  wet  rag 
or  sponge. 

23.  The  class  rooms  shall  be  washed  weekly,  and  disinfected  with  a  solution 
of  bichloride  of  a  strength  of  I  to  the  thousand. 

24.  The  children's  clothes  shall  be  clean  before  allowing  them  to  enter  the 
class,  and  after  recess  they  shall  wash  their  hands. 

WHOOPING  COUGH. 

Whooping  cough  is  the  disease  which  most  rarely  develops  in  an  epidemic 
form,  yet  it  has  sometimes  developed  in  that  form,  though  not  in  all  the  depart- 
ments of  the  Republic. 

On  the  other  hand  these  epidemics  have  not  been  of  great  importance,  and 
consequently  the  cases  frequently  observed  have  been  isolated  cases  which  have 
not  formed  any  epidemic  foci. 

The  number  of  deaths  has  been  greatly  diminished  during  the  last  ten  years, 
shown  by  the  following  table: 


THIRD  INTERNATIONAL  SANITARY  CONVENTION  243 

DEATHS. 

1897  to  1906. 

First  five  years.  Second  five  years. 

1897 58  1902 23 

1898 12  1903 66 

1899 20  1904 19 

1900 43  I90S 13 

1901 65  1906 52 


198  173 

Grand  total 371 

As  in  the  case  of  other  contagious  diseases,  the  following  rules  have  been 
prescribed  concerning  whooping  cough : 

General  Rules  for  the  Prophylaxsis  of  Whooping  Cough. 

The  contagious  agent  of  whooping  cough  is  found  in  the  matter  expelled  by 
the  cough  and  the  vomit.  This  disease  attacks  especially  children,  and  the 
younger  the  latter  are  the  more  dangerous  the  disease. 

I. 

Precautions  to  be  Taken  in  Order  to  Prevent  the  Patients  of  Whooping  Cough 
From  Transmitting  the  Disease. 

1.  The  patients  shall  be  isolated  during  the  whole  course  of  the  disease,  and 
until  three  weeks  shall  have  elapsed  from  the  date  of  the  complete  disappearance 
of  the  cough. 

2.  Care  shall  be  taken  to  collect  the  products  of  the  expectoration  and  vomit 
in  wooden,  earthenware,  iron  or  porcelain  vessels  containing  a  solution  of  sul- 
phate of  copper  in  the  proportion  of  50  per  thousand,  and  in  case  this  should 
not  be  possible,  the  places   where   such  products   have   been  thrown   shall   be 
cleaned  with  boiling  water. 

3.  The   clothes   and   textiles   contaminated   should   be   immersed   in   boiling 
water. 

4.  The  floors  of  the  places  frequented  by  persons  having  whooping  cough 
shall  not  be  swept,  and  the  dust  shall  be  removed  one  or  more  times  a  day  by 
means  of  wet  rags  which  shall  be  disinfected. 

5.  All  curtains,  carpets  and  furniture  which  are  not  absolutely  indispensable 
shall  be  removed  from  the  dormitory  of  the  patient. 

6.  The  rooms  shall  be  ventilated  often,  especially  in  the  morning,  and  during 
the  hours  in  which  the  rays  of  the  sun  may  penetrate  therein. 

7.  The  mattresses  and  bedclothes  shall  be  exposed  to  the  sun  and  the  open 
air. 

II. 

Precautions   Which  Should  be  Taken  in   Order  to  Prevent  Healthy  Persons 
From  Contracting  the  Contagion. 

A.    Private  Measures. 

1.  Healthy  children  shall  be  kept  from  their  suspected  or  sick  companions. 

2.  Children   should  be   forbidden   to   attend  places   where  there   are   many 
people  assembled. 

3.  The  mouth  and  the  nose  shall  be  frequently  disinfected  with  a  solution 
of  boric  acid  in  the  proportion  of  4  per  hundred,  mixed  with  a  quantity  of  boil- 
ing water  equivalent  to  one-half  of  the  solution. 

4.  It  shall  be  the  duty  of  persons  attending  children  with  whooping  cough 
to  be  entirely  clean  and  to  disinfect  their  mouths  and  noses  frequently  with  a 
solution  of  boric  acid. 


244  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

Clothes  that  have  been  contaminated  with  matters  thrown  off  through  ex- 
pectoration and  vomit,  shall  be  properly  disinfected. 

B.    Precautionary  Measures  to  be  Taken  at  Schools. 

1.  The  class  rooms  shall  be  entirely  ventilated  by  opening  the  doors  and  win- 
dows during  recess  hours,  and  after  the  pupils  leave. 

2.  The  floors  shall  not  be  swept,  but  the  dust  shall  be  removed  by  means  of 
a  wet  rag  or  sponge. 

3.  The  class  rooms  shall  be  washed  weekly,  after  which  they  shall  be  dis- 
infected with  a  solution  of  bichloride  in  the  proportion  of  I  per  thousand. 

4.  Care  should  be  taken  to  see  that  the  children  wear  clean  clothes  before 
entering  the  class  room,  and  they  shall  be  required  to  wash  their  hands  after 
recesses. 

5.  Every  child  with  symptoms  of  whooping  cough  shall  be  kept  away  from 
the  school,  and  shall  only  be  admitted  when  it  presents  a  medical  certificate 
showing  that  the  child  is  not  afflicted  with  said  disease,  or  that  three  weeks  have 
elapsed  since  its  recovery  therefrom. 

6.  The  confirmed  cases  shall  be  reported  to  the  principals  of  the  schools,  so 
that  they  may  watch  such  children  as  live  in  houses  occupied  by  those  afflicted 
with  the  disease. 

EXOTIC  DISEASES. 
II. 

We  designate  by  this  name  such  diseases  as  do  not  exist  in  the  country, 
and  which  have  been  imported,  or  may  be  imported  hereafter,  such  as  yellow 
fever,  cholera,  the  bubonic  plague  and  beri-beri. 

As  to  yellow  fever  and  cholera,  we  would  have  nothing  to  add  to  what  we 
said  in  the  report  presented  to  the  First  International  Sanitary  Convention, 
which  was  held  in  Washington  in  1902,  but,  inasmuch  as,  since  then,  there 
have  been  adopted  provisions  of  an  international  character  in  order  to  prevent 
the  importation  of  said  diseases,  it  seems  to  us  that  it  would  be  proper  to  make 
a  brief  review  of  the  epidemics  of  yellow  fever  and  cholera,  and  also  of  the 
appearance  and  course  of  the  bubonic  plague,  before  we  refer  to  the  aforesaid 
provisions. 

Therefore,  we  shall  commence  our  statement  with  yellow  fever,  this  having 
been  the  first  of  the  exotic  diseases  which  invaded  our  country,  and  was  epi- 
demically developed  at  Montevideo. 

YELLOW  FEVER. 

Yellow  fever  was  not  known  in  Uruguay  until  1857.  Its  importation,  which 
occurred  in  the  month  of  February  of  said  year,  was  made  through  some  in- 
fected vessels  which  had  arrived  from  Rio  de  Janeiro,  and  which  probably 
were  not  kept  in  strict  isolation,  inasmuch  as  several  sailors  broke  away  from 
the  isolation  and  soon  after  contracted  the  disease.  From  that  moment,  new 
cases  were  more  and  more  frequent,  and  were  spread  through  different  places 
of  the  city  and  mainly  in  the  low  grounds  of  the  city  near  the  bay. 

The  epidemic  that  was  then  developed  lasted  until  the  month  of  June,  caus- 
ing about  1,000  deaths. 

After  many  years,  yellow  fever  was  again  imported  from  Rio  de  Janeiro.  The 
epidemics  which  occurred  in  1872  and  1873,  the  only  ones  after  1857,  did  not 
last  so  long  nor  were  they  of  such  a  malignant  character.  The  first  of  them 
broke  out  in  January,  and  ceased  in  the  month  of  March,  having  caused  142 
deaths;  the  second  also  commenced  in  the  month  of  January,  and  disappeared 
in  the  month  of  May  after  having  caused  329  victims. 

The  fourth  and  last  epidemic,  also  imported  from  Brazil,  and  which  occurred 
in  1878,  may  be  considered  as  the  mildest  of  all  of  them  and  of  the  shortest 
duration.  Indeed,  it  only  caused  40  deaths,  commencing  in  February  and  dis- 
appearing in  May.  Subsequently  no  more  cases  of  yellow  fever  have  been  re- 
ported, except  one  that  occurred  in  Montevideo  in  January,  1903.  When  the 
sanitary  authorities  were  advised  of  the  existence  of  said  case,  they  immedi- 
ately adopted  the  proper  measures  to  prevent  the  spread  of  the  disease. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  245 

From  this  brief  review,  it  will  be  seen  that  Uruguay  has  been  free  from  said 
disease  since  1878,  in  spite  of  the  fact  that  there  have  been  great  epidemics  of 
yellow  fever  in  Rio  de  Janeiro,  and  notwithstanding  the  yearly  increase  in  the 
number  of  infected  vessels  arriving  at  the  port  of  Montevideo. 

There  is  no  doubt  that  if  strict  sanitary  vigilance  had  not  been  observed  on 
vessels  coming  from  said  country,  it  would  have  been  very  difficult  to  prevent 
new  invasions  of  the  disease  during  such  a  long  period  of  time. 

Fortunately  the  danger  has  continually  decreased  since  the  sanitary  condi- 
tions of  Rio  de  Janeiro  commenced  to  improve,  and  it  is  hoped  that  said 
danger  will  entirely  disappear  if  the  new  processes  which  have  been  employed 
to  exterminate  yellow  fever  continue  to  give  equally  good  results  as  those 
secured  heretofore. 

CHOLERA. 

Ten  years  after  the  appearance  of  the  first  epidemic  of  yellow  fever,  cholera 
broke  out,  having  been  imported  from  Genoa  bv  a  vessel  on  board  of  which 
several  cases  occurred  during  the  voyage.  After  completing  its  quarantine  and 
securing  free  practique,  the  first  case  occurred  atnong  the  passengers  who  landed 
in  Montevideo  from  said  vessel. 

This  epidemic  commenced  in  the  month  of  December,  1866,  and  disappeared 
in  the  month  of  May,  1867,  after  having  caused  128  deaths. 

The  second  epidemic,  which  was  also  imported,  and  of  greater  importance 
than  the  previous  one,  since  it  extended  to  several  rural  departments,  com- 
menced in  December,  1867,  and  disappeared  in  April,  1868. 

The  number  of  deaths  caused  during  that  time  amounted  to  2,955. 

Another  epidemic  occurred  in  1886,  which  like  the  second  one,  spread  to 
some  of  the  most  important  cities  of  the  interior  of  the  country.  It  com- 
menced in  November  and  disappeared  in  MSarch,  having  caused  535  deaths. 

The  fourth  and  last  epidemic  broke  out  in  January,  1895,  and  disappeared  in 
May  of  the  same  year,  having  caused  105  deaths. 

In  these  last  two  epochs  (1886  and  1895),  cholera  was  imported,  as  it  was  in 
the  other  instances,  by  persons  coming  from  infected  ports. 

THE  BUBONIC  PLAGUE. 

Until  1901  there  had  been  no  cases  of  Bubonic  plague  in  Uruguay.  The  first 
that  occurred  was  in  the  second  half  of  January  of  said  year,  the  victim  having 
been  the  foreman  of  one  of  the  custom  house  warehouses,  where  a  large  number 
of  rats  had  died. 

The  bacteriological  examination  which  was  made,  soon  demonstrated  that  the 
patient  had  the  bubonic  plague,  the  same  as  the  rats  found  dead.  After  isolat- 
ing the  patient  and  adopting  the  proper  precautionary  measures,  the  occurrence 
of  other  cases  was  prevented. 

After  a  period  of  six  months  in  which  good  sanitary  conditions  prevailed, 
two  new  cases  occurred.  The  investigations  made  in  order  to  determine  its 
origin,  demonstrated  that  one  of  the  patients  came  from  a  bakery  which  had 
just  received  a  shipment  of  cloth  bags  from  another  similar  establishment  of 
Asuncion,  Paraguay,  where  there  had  occurred  cases  of  the  bubonic  plague, 
and  that  the  latter  had  visited  the  house  of  the  former.  As  soon  as  the  second 
epidemic  was  checked,  some  time  elapsed  before  new  cases  of  said  disease 
occurred  until  April,  1902,  when  it  was  discovered  that  in  other  customhouse 
warehouses,  some  dead  rats  had  been  found.  After  it  was  proved  that  they 
were  affected  with  the  plague,  and  the  sanitary  authorities  having  learned  that 
there  were  in  said  warehouses  a  lot  of  coffee  bags  which  had  been  brought 
from  Rio  de  Janeiro,  it  was  ordered  that  said  bags  should  be  destroyed  by  fire, 
and  substituted  with  new  ones. 

The  four  laborers  who  worked  in  that  operation  were  taken  sick  immedi- 
ately, and  two  of  them  died. 

Two  months  later,  there  occurred  another  case  in  the  person  of  a  laborer 
of  a  mill,  but  it  was  impossible  to  discover  the  origin  of  the  contagion. 

Since  that  time  all  the  investigations  made  for  the  purpose  of  determining 
whether  the  new  cases  could  be  attributed  to  the  reimportation  of  the  germs 
of  the  bubonic  plague,  were  unsuccessful,  because  the  sanitary  authorities  were 
not  able  to  prove  that  the  patient  had  contracted  the  disease  through  having 
received  or  handled  contaminated  articles. 


246  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

For  this  reason  it  was  supposed  that  perhaps  the  contagion  had  remained  in 
the  rats,  having  been  transmitted  by  them  to  persons.  Whether  this  is  true  or 
not,  the  fact  is  that  the  bubonic  plague  has  not  been  epidemically  developed  in 
Montevideo,  as  has  happened  in  other  countries,  nor  has  it  formed  more  or 
less  important  foci,  nor  has  it  extended  to  other  localities.  In  addition  to  the 
above,  the  only  cases  discovered  have  been  in  one  of  the  infected  houses  where 
there  had  previously  been  a  patient  having  a  complication  of  pneumonia  and 
the  plague. 

Therefore,  it  can  be  truthfully  said,  that  the  bubonic  plague  in  Montevideo 
has  been  characterized  by  its  sporadic  form,  and  by  the  slight  mortality  it  has 
caused. 

The  following  table  shows  the  number  of  cases  and  deaths  which  occurred 
from  1901  to  1907: 

Cases  and  Deaths  From  Bubonic  Plague. 
1901  to  1907. 

Year.  Cases.  Deaths. 

1901 3  3 

1902 8  5 

1903 3  o 

1904 7  5 

1905 2  o 

1906 6  2 

1907 18  8 

47  23 

In  Montevideo,  the  same  as  in  other  cities,  it  has  been  noted  that  the  majority 
of  the  patients  of  the  bubonic  plague  were  persons  employed  in  custom  houses, 
bakeries,  vermicelli  factories,  mills  and  domestic  fruit  deposits  where  bags  with 
cereals  are  frequently  received,  and  in  which  rats  some  times  enter.  It  has  also 
been  observed  that  the  greatest  number  of  cases  occur  in  summer  and  autumn, 
that  is  to  say,  during  the  seasons  in  which  the  work  in  the  aforesaid  establish- 
ments is  increased,  and  when  the  trade  in  cereals  is  most  active. 

In  order  to  complete  this  statement  of  data,  we  will  add  the  provisions  relating 
to  the  prophylaxis  of  yellow  fever,  cholera,  and  the  bubonic  plague,  calling  atten- 
tion to  the  fact  that  said  provisions  are  none  other  but  those  agreed  upon  by  the 
delegates  of  the  Argentine  Republic,  Brazil,  Paraguay,  and  Uruguay,  when  they 
met  at  Rio  de  Janeiro  for  the  purpose  of  studying  and  discussing  the  bases  of 
the  International  Sanitary  Convention  of  1904. 

We  transcribe  only  such  provisions  as  relate  to  land  and  maritime  prophy- 
laxis, without  prejudice  to  mentioning  some  others  that  are  especially  inter- 
esting. 

TITLE  II. 
Concerning  Land  Prophylaxis. 

Art.  15.  Whenever  the  infected  locality  is  situated  near  the  frontiers  of  the 
contracting  countries,  the  precautionary  sanitary  measures  shall  be  applied  in 
accordance  with  the  following  principles: 

a.  The  mail  between  the  infected  country  and  those  not  infected  shall  not  be 
interfered  with,  sanitary  limits  and  land  quarantine  being  hereby  abolished. 

b.  The  high  contracting  parties  reserve  the  right  to  limit  the  places  on  the 
frontier  through  which  the  transit   of  passengers   and    merchandise    may    be 
effected. 

c.  Passengers  shall  be  subjected  to  medical  inspection  and  the  sanitary  au- 
thorities may  prohibit  the  passage  of  the  suspected  patients  or  convalescents  of 
any  of  the  aforesaid  diseases. 

d.  Passengers  shall  be  under  vigilance  for  the  period  of  time  corresponding 
to  that  of  the  incubation  of  each  of  the  diseases,  the  importation  of  which  it  is 
sought  to  prevent. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  247 

e.  In  the  case  of  cholera  or  the  bubonic  plague,  the  clothes  in  general  and  all 
such  articles  as  are  susceptible  of  transmitting  the  disease,  shall  be  thoroughly 
disinfected. 

In  other  articles  of  these  rules  and  regulations  it  has  been  prescribed  that  the 
sanitary  vigilance  of  first  and  second  class  passengers,  shall  be  effected  on  land, 
and  that  of  the  steerage  passengers  shall  be  exercised  in  their  quarters  on  the 
ships,  under  such  restrictions  as  the  sanitary  authorities  may  deem  advisable. 

On  the  other  hand,  it  has  been  decided  not  to  delay  the  admission  of  the  mails, 
subjecting  to  disinfection  only  postal  parcels. 

In  addition  to  the  above,  such  sanitary  measures  as  might  be  necessary  to 
apply  to  vessels  coming  from  countries  not  belonging  to  the  convention,  must 
be  in  accordance  with  the  provisions  contained  therein. 

From  the  foregoing,  it  will  be  seen  that  the  Convention  of  Rio  de  Janeiro  has 
accepted  the  most  liberal  of  sanitary  regimes,  omitting  the  vigilance  of  first  and 
second  class  passengers  in  the  lazarettos  or  on  board  the  vessels,  and  allowing 
the  admission  of  the  cargo  without  any  restriction.  Therefore,  it  may  be  said 
that  it  differs  from  other  conventions  by  the  fact  of  having  abolished  entirely 
the  old  sanitary  practices  which  are  gradually  disappearing,  and  by  having  rec- 
ognized that  what  was  formerly  done  at  lazarettos  or  on  the  vessels,  can  now 
be  done  on  land  without  thereby  endangering  the  sanitary  condition  of  the 
country. 

BERI-BERI. 

We  have  little  to  say  concerning  this  disease,  because  it  is  now  more  tnan 
seventeen  years  since  a  case  has  occurred  in  Montevideo,  owing  to  the  fact  that 
the  landing  in  the  country  and  attendance  of  beri-beri  patients  in  the  ordinary 
hospitals  is  prohibited. 

Before  1889,  that  is  to  say  when  there  was  no  sanitary  provision  prohibiting 
the  admission  of  said  patients  into  general  hospitals,  such  patients  frequently  were 
admitted  and  attended,  especially  at  the  English  Hospital,  the  greater  number 
of  them  being  patients  who  landed  from  Brazilian  vessels  belonging  to  the  Navy. 

It  was  after  that  time  that  it  was  prescribed  that  such  patients  should  be  at- 
tended at  the  lazaretto,  and  since  then  all  patients  of  beri-beri  arriving  at  the 
port  must  be  transferred  to  said  establishment,  in  accordance  with  the  provi- 
sions of  the  rules  and  regulations  of  Maritime  Sanitation. 

The  majority  of  the  cases  occurring  in  the  last  few  years  have  come  from 
merchant  vessels,  mainly  from  certain  ports  of  North  America,  such  as  Pensa- 
cola,  Mobile,  etc. 

From  1902  to  1006,  the  number  of  beri-beri  patients  arriving  at  the  port  of 
Montevideo  and  landing  at  the  lazaretto,  amounted  to  32,  as  will  be  seen  by 
the  following  tables: 

Beri-Beri  Patients  Landed  at  the  Lazaretto  of  Isla  de  Flores. 

Year  Cases 

1902 6 

1903     2 

1904. 10 

1905 5 

1906 9 

32  , 

Concerning  Sanitary  Treatment  of  Vessels  Infected  With  Beri-Beri. 
(Rules  and  Regulations  of  Maritime  Sanitation.) 

Art.  47.  Vessels  infected  with  beri-beri  shall  be  subject  to  the  following  sani- 
tary treatment: 

a.  Landing  of  the  patient  or  patients  in  the  lazaretto  for  such  treatment  as 
may  be  proper,  which  shall  be  applied  while  the  patient  is  isolated. 

b.  The  disinfection  of  the  clothes  of  the  passengers  and  crew  in  the  stove 
provided  on  board  the  vessel,  in  the  presence  of  two  officers  representing  the 
sanitary  authority,  or  in  that  of  the  officers  of  the  lazaretto,  according  to  cir- 
cumstances. 

c.  The  free  practique  of  the  vessel  as  soon  as  the  disinfection  is  completed. 


248  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

MALARIA. 

This  disease  does  not  exist  in  Uruguay,  and  such  cases  as  sometimes  occur 
come  from  countries  where  malaria  is  endemic. 

We  shall  treat  granulous  conjunctivitis  or  trachoma  in  a  separate  chapter, 
in  order  to  state  that  it  is  a  disease  which  has  been  observed  for  a  long  time 
in  the  Orphans  and  Foundling  Asylum  of  Montevideo,  but  which  at  present 
has  not  only  diminished,  but  is  about  to  disappear,  since  the  isolation  of  the 
patients  has  been  prescribed. 

Such  cases  as  oculists  have  occasion  to  treat  are  isolated  cases  which  here- 
tofore have  not  formed  foci. 

III. 

Sanitation  of  the  Port  of  Montevideo. 

In  addition  to  the  construction  work  of  the  port,  carried  out  so  that  the  har- 
bour of  Montevideo  may  be  provided  with  all  the  necessary  means  of  easy 
access  and  sufficient  shelter,  in  order  that  vessels  may  load  and  unload  without 
encountering  the  inconveniences  and  difficulties  met  with  in  open  ports.  Besides 
other  no  less  important  work  relating  to  sanitation  have  been  effected — work 
commenced  in  1903,  the  greater  part  of  which  was  completed  during  the  present 
year. 

The  object  of  said  work  was  to  avoid  the  drainage  of  sewerage  into  the  bay, 
and  to  facilitate  the  drainage  of  a  well  populated  zone  not  having  a  system  of 
sewers.  Consequently,  in  order  to  obtain  this  result,  it  became  necessary  to 
construct  two  great  water  conduits,  and  some  auxiliary  conduits,  to  receive 
said  sewerage,  as  well  as  the  waters  coming  from  the  new  wharves,  and  a  part 
of  the  rain  water,  and  convey  them  to  the  southern  coast  of  the  River  Plate. 

Simultaneously  with  those  works  other  accessory  works  have  been  completed, 
namely,  the  cleaning  deposits  of  the  water  conduits,  which  have  a  capacity  of 
10,000  liters  of  water  each,  the  emptying  chambers,  and  common  emptying  con- 
duits, air  holes,  storm  spouts,  and  ventilating  chimneys. 

Of  the  two  great  water  conduits  the  main  conduit  is  4,571  meters  67  centi- 
meters, of  which  1,362  meters  60  centimeters  have  been  constructed  in  the  form 
of  a  tunnel  in  the  rock. 

On  the  south  side  it  empties  into  Paraguay  street,  and  thence  in  a  northerly 
direction  through  Ibicui  Street,  and  General  Rendeau  Avenue,  to  Tenientes 
Street,  and  thence  in  an  easterly  direction  through  the  same  street  and  that  of 
Cunapini  to  Republica  Street,  where  it  originates.  The  following  auxiliary 
water  conduits  connect  with  this  main  water  conduit :  On  the  left  with  that 
of  Orillas  del  Plata  Street,  which  ends  in  Florida  Street,  and  with  that  of 
Miguelete  Street,  which  extends  to  Dayman  Street.  On  the  right,  it  connects 
with  that  of  Miguelete  Street,  and  New  York  Street.  The  length  of  said  tribu- 
taries is  2,132  meters  12  centimeters. 

The  secondary  water  conduit  begins  where  one  of  the  tributaries  of  the  prin- 
cipal water  conduit  ends,  that  is  to  say,  in  Orillas  del  Plata,  and  Florida  Streets. 
From  thence  it  follows  to  Rampla  Street,  and  then  it  turns  and  runs  through 
Piedras  Street,  and  reaches  Juan  L.  Cuestas  Street,  through  which  it  passes  until 
it  empties  into  the  river  through  Guarani  Street.  It  has  a  length  of  2,198 
meters  48 -centimeters,  of  which  only  1473  meters  48  centimeters  have  been  con- 
structed owing  to  the  fact  that  the  works  of  the  filling  of  the  port  have  not  yet 
been  finished.  This  is  the  reason  why  only  one  of  the  drains  has  been  finished, 
namely,  that  of  Tenientes  Street,  which  connects  with  the  main  drain. 

The  cost  of  said  important  work  was  estimated  at  $1,000,000,  of  which  $692,- 
037.30  has  been  spent,  thus  leaving  $307,962.70  for  the  work  not  yet  finished. 

Sanitary  Works  in  Rural  Departments, 

The  studies  made  relating  to  the  sanitation  of  cities  and  important  towns  of 
the  Republic,  which  it  was  impossible  to  undertake  until  now,  have  just  been 
started  in  some  departments  in  conformity  with  a  decree  issued  by  the  Gov- 
ernment in  July  of  the  current  year. 

In  said  decree  are  set  forth  the  reasons  which  have  been  borne  in  mind  in 
order  to  hasten  the  preliminary  works,  as  well  as  the  aims  of  the  Government 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  249 

on  directing  that  said  works  be  effected  in  accordance  with  a  general  plan  of 
sanitation,  which  shall  be  completed  within  a  short  time. 

In  order  to  carry  out  everything  relating  to  said  works,  a  National  Bureau  of 
Sanitation  shall  be  established,  the  founding  of  which  the  Government  will  re- 
quest of  the  Congress,  as  well  as  the  means  necessary  for  the  execution  of  such 
work  as  will  be  proposed  at  the  proper  time. 

As  above  stated,  the  preliminary  steps  have  already  been  taken  by  certain 
departments,  the  conditions  of  which  are  favorable  to  the  establishment  of  two 
water  supply  systems,  and  disposal  of  sewage  without  great  difficulty.  It  can, 
therefore,  be  said  that  the  sanitation  of  the  important  towns  of  the  coast  and 
interior  of  the  Republic  will  be  carried  out  without  delay,  inasmuch  as  that  is 
the  wish  of  the  Executive  Power. 

The  decree  referred  to  is  as  follows: 

MONTEVIDEO,  July  16,   1907 

Whereas:  I.  Sanitation  Works  can  not  longer  be  delayed,  and  demand  spe- 
cial attention  on  the  part  of  Governments,  because  of  their  highly  humanitarian 
aims,  by  virtue  of  which  society  contracts  a  debt  with  its  members; 

2.  That  their  immediate  execution  in  our  Republic  should  be  and  is  the  con- 
stant aim  of  the  present  administration; 

3.  That,  consequently,  and  notwithstanding  the  different  provisions  now  exist- 
ing here  and  there  in  the  laws  relating  to  the  founding  of  the  National  Board 
of  Health,  of  the  National  Department  of  Engineers,  and  of  the  Economic- 
Administrative  Boards,  the  Executive   Power  prepares  a  bill   relating  to  the 
general  sanitation  of  all  centers  of  population  of  our  territory,  and  with  the 
simultaneous  appropriation  of  funds,  which  will  render  possible  to  commence 
without  delay  the  solution  of  such  an  important  problem  in  accordance  with  the 
great  advancement  that  science  and  experience  has  taught  us  on  the  matter — a 
solution  which  it  is  not  possible  for  a  single  administration  to  carry  out  in  all 
its  extent,  inasmuch  as  it  comprises  several  phases  that  are  different  stages  of 
a  well  accentuated  character,  and  which  individually  are  of  the  utmost  im- 
portance ; 

4.  That  while  the  said  law  is  being  prepared  and  approved,  not  only  is  there 
not  any  objection  in  starting  and  hastening  as  much  as  possible  said  preliminary 
studies,  in  order  to  fix  and  plan  the  most  necessary  and  suitable  drainage  and 
sanitary  works,  thus  uniting  and  properly  directing  the  works  urgently  demanded 
by  public  health,  and  for  which  there  exists  a  special  public  need. 

5.  That  the   National  Department  of  Engineers,  in  view  of  its  numerous 
scientific  tasks,  has  not  sufficient  personnel  to  undertake  alone  such  preliminary 
studies,  and  that,  on  the  other  hand,  the  magnitude  of  the  general  plan  of  sani- 
tation of  our  cities  and  towns,  considered  from  its  many  phases,  demands  the 
establishment  of  a  special  bureau  provided  with  a  certain  autonomy,  and  cer- 
tain powers  of  its  own,  to  which  shall  be  entrusted  the  exclusive  study  and  solu- 
tion of  the  many  questions  of  a  technical,  sanitary,  administrative  and  legal 
character,  connected  with  the  aforesaid  plan  or  project. 

6.  That  without  giving  to  the  General  Bureau  of  Sanitation  such  ample  and 
complete  organization  as  the  same  may  be  entitled  to,  when  the  law  referred  to 
has  been  approved,  it  is  possible,  without  any  difficulty  so  far  as  the  Administra- 
tion is  concerned,  to  now  outline  a  plan  of  organization,  establishing  with  a  lim- 
ited technical  personnel  a  division  which,  later  on,  when  circumstances  permit 
the  carrying  out,  without  difficulty,  the  proper  program  of  the  Executive  Power, 
will  serve  as  a  training  school. 

7.  That  in  view  of  the  above,  and  bearing  in  mind  that  the  duty  of  this 
latter  personnel  should,  for  the  time  being,  be  limited  to  determining  the  general 
trend  of  the  preliminary  studies  to  the  sanitation  plans,  and  to  carrying  out 
simple  topographical  operations,  making,  at  the  same  time,  the  proper  hydraulic 
tests  and  superficial  geological  surveys  of  a  general  character. 

The  President  of  the  Republic  decrees  i 

Article  I.  Until  the  National  Bureau  of  Sanitation  is  organized  in  accord- 
ance with  the  respective  law,  the  approval  of  which  the  Executive  Power  shall 
recommend  in  due  time,  the  National  Department  of  Engineers  shall  establish 
a  technical  division  for  making  the  preliminary  studies  on  sanitation  works. 

Art.  2.    The  personnel  of  said  division,  for  the  time  being,  shall  be  as  follows : 

I.    A  technical  expert  familiar  with  said  preliminary  studies,  and  especially 


25O  THIRD  INTERNATIONAL  SANITARY  CONVENTION. 

competent  and  of  great  experience  in  the  preparation,  arrangement  and  execu- 
tion of  sanitary  plans  by  modern  processes. 

This  special  technical  expert  shall  be  the  chief  of  the  corresponding  division 
and  his  services  shall  be  engaged  in  due  time  by  the  Department  of  Public 
Works,  which  is  hereby  authorized  for  that  purpose. 

2.  Three  operators. 

3.  Three  draftsmen  who  shall  act  as  assistants  to  the  operators. 

4.  Four  laborers  for  each  operator. 

The  services  rendered  by  this  personnel  shall  not  be  regarded  as  those  of 
regular  Government  employees. 

Art.  3.  The  compensation  of  the  said  personnel  are  fixed  in  the  following 
amount,  and  shall  be  paid  as  expenses  and  not  as  salary: 

1.  The  chief  of. the  division  shall  receive  a  monthly  amount,  which,  including 
the  special  traveling  expenses,  shall  never  exceed  $300. 

2.  The  operators  shall  receive  $120  each. 

3.  The  assistant  draftsmen  shall  receive  $80  each. 

4.  The  laborers  shall  receive  $25  each. 

The  transportation  expenses  of  said  personnel  to  the  places  where  they  have 
to  make  said  studies,  shall  be  borne  by  the  State. 

Art.  4.  The  instruments,  tools,  utensils  and  other  necessary  appliances  for 
effecting  said  -studies,  and  preservation  of  landmarks,  shall  be  supplied  by  the 
National  Department  of  Engineers. 

Art.  5.  It  shall  be  the  duty  of  the  Chief  of  the  National  Department  of  En- 
gineers, to  issue,  in  accord  with  the  Department  of  Public  Works,  the  general 
and  private  instructions  concerning  the  character  of  the  studies  to  be  made,  the 
manner  in  which  the  same  can  be  carried  out  and  the  preservation  thereof,  as 
well  as  the  number  and  manner  in  which  the  plans  and  other  data  shall  be  pre- 
sented. 

Art.  6.  Until  the  expenses  incurred  by  the  sanitation  studies  are  included  in  the 
proper  budget,  they  shall  be  charged  in  equal  parts  to  incidental  expenses  of 
the  departments  of  the  Interior  and  Public  Works,  to  be  reimbursed  as  soon  as 
the  Congress  shall  make  the  proper  appropriation  for  said  works. 

Art.  7.  The  studies  ordered  shall  be  undertaken  in  groups  of  three  centers  of 
population,  beginning  with  Mercedes,  San  Jose  and  Minas,  followed  by  Salto, 
Paysandu,  and  Durazno,  to  be  continued  with  others  to  be  designated  in  due 
time. 

Art.  8.    Let  it  be  communicated,  inserted  in  the  proper  register,  and  published. 

WATER  SUPPLY. 

The  first  steps  taken  asking  the  Government  to  provide  the  City  of  Montevideo 
with  a  good  water  supply  were  started  in  1867,  but  the  works  which  were  planned 
to  that  end  were  not  completed  until  the  middle  of  1871,  and  shortly  afterwards 
the  new  system  was  inaugurated,  the  importance  of  which  was  immediately  ac- 
knowledged, not  only  because  the  city  lacked  a  proper  supply  of  water  at  that 
time,  but  also  because  the  only  water  that  could  be  used  was  obtained  from 
cisterns  and  wells  imperfectly  constructed. 

The  installation  of  the  present  system  of  water  supply  from  the  Santa  Lucia 
River,  dates  from  that  time.  The  water  is  brought  from  a  place  situated  at  a 
distance  of  58  kilometers  from  the  city.  From  that  place  the  water  is  conveyed 
to  four  decantation  reservoirs,  having  an  aggregate  capacity  of  54,000,000  liters, 
and  from  thence  it  is  carried  to  the  purifying  apparatus  and  filters,  and  it  is 
finally  conveyed  to  three  distributing  reservoirs,  which  have  a  capacity  of 
60,000,000  liters.  In  addition  to  said  reservoirs,  which  are  installed  in  a  place 
called  Las  Piedras,  at  a  distance  of  40  kilometers  from  Montevideo,  there  are 
two  others  in  a  place  called  Blanqueada  near  the  city,  having  a  capacity  of 
500,000  liters,  and  serve  to  supply  water  to  the  towns  of  Union  and  Maronas, 
which  constitute  a  part  of  the  Department  of  Montevideo. 

In  order  to  purify  and  filtrate  the  water,  the  Company  that  supplies  the  water 
has  at  its  disposal  the  aforesaid  decantation  reservoirs,  together  with  three 
apparatus  of  the  Anderson  type,  and  five  filters  of  1,200  square  meters  each,  which 
can  supply  up  to  21,500,000  liters  in  24  hours.  The  Anderson  apparatus,  the 
object  of  which  is  to  diminish  considerably  the  quantity  of  bacteria  and  of  or- 
ganic matter,  can  purify  22,500  cubic  meters  in  an  equal  period  of  time. 


THIRD  INTERNATIONAL  SANITARY  CONVENTION.  251 

The  two  reservoirs  which  receive  the  filtered  water  have  a  capacity  of  17,- 
000,000  liters,  that  is  to  say,  8,500,000  liters  each. 

In  addition  to  the  above  installation,  a  house  is  being  built  at  the  place  where 
the  principal  establishment  is  located,  and  a  new  machine  will  be  set  up  there, 
which  will  do  the  double  work  of  extracting  the  water  from  the  river,  and 
pumping  the  same  into  the  purifying  apparatus,  and  at  the  same  time,  after 
the  water  is  purified,  it  will  pump  it  into  the  distributing  reservoir  of  Las 
Piedras. 

On  the  other  hand,  the  preliminary  works  are  being  done  in  order  to  lay  a 
line  of  steel  mains,  having  a  diameter  of  0.76  meters,  which  will  be  parallel  to 
the  line  which  runs  to  the  Santa  Lucia  River,  and  to  the  aforesaid  reservoir,  and 
another  line  of  cast  iron  mains,  having  a  diameter  of  0.457  meters,  from  that 
point  to  Montevideo. 

The  drawings  will  show  the  route  over  which  said  lines  will  be  extended. 

The  mains  which  distribute  the  water  are  laid  in  all  the  streets  of  the  city, 
and  in  a  considerable  part  of  the  suburbs.  They  are  growing  daily  in  extent, 
because  branches  are  frequently  laid  in  those  places  where  new  buildings  are 
constructed. 

The  demands  for  the  installation  of  the  water  supply  service  increase  in  the 
same  ratio,  because  nearly  all  of  the  new  houses  require  said  water  service. 

The  number  of  houses  provided  with  the  water  supply  service  is  20,000.  Of 
these  only  14,000  are  now  using  the  water  supply.  The  average  daily  consump- 
tion during  the  previous  year  was  8,200,000  liters. 

During  the  same  year  the  analysis  made  by  the  Municipal  Chemical  Labora- 
tory gave  an  average  of  i.S6%  of  organic  matter,  a  much  larger  proportion  than 
that  allowed  in  other  countries  which  have  stricter  provisions  concerning  the 
matter  than  we  have. 

MARITIME  DISINFECTING   STATION. 

A  short  time  after  the  International  Sanitary  Convention  of  Rio  de  Janeiro 
was  held,  the  National  Board  of  Health  conceived  the  plan  of  establishing  a 
disinfecting  plant  at  the  port,  so  that  the  clothes  of  the  passengers  might  be 
disinfected  there,  in  case  it  were  necessary  to  do  so,  instead  of  carrying  out  that 
operation  at  the  lazaretto  of  the  Isla  de  Flores  where  it  has  always  been  done. 

With  that  end  in  view,  it  applied  to  the  Government,  and  obtained  the  sup- 
port of  the  same,  in  order  to  commence  the  works  relating  to  the  preparation 
and  presentation  of  the  plans  of  said  work,  and  for  the  purpose  of  carrying 
out  the  same. 

In  accordance  with  what  the  Board  of  Health  has  already  decided,  said  build- 
ing will  consist  of  two  stories:  In  the  lower  one  there  will  be  constructed  the 
different  sections  of  the  disinfecting  plant,  such  as  the  offices  for  the  personnel, 
a  place  for  disinfection  by  moist  heat  and  chemical  agents,  together  with  its 
corresponding  deposits  for  the  disinfecting  ^agents,  formaldehyde  generators 
and  atomizers,  rooms  for  passengers  and  their  baggage,  and  finally  lavatories, 
baths  and  toilets.  On  the  second  floor  there  will  be  the  necessary  rooms  for 
the  offices  of  the  Sanitary  Inspection  of  the  port,  which  is  in  charge  of  the  mari- 
time sanitary  service. 

It  goes  without  saying  that  the  carrying  out  of  said  work,  in  which  the  Board 
of  Health  is  deeply  interested,  will  be  of  the  utmost  usefulness,  inasmuch  as  it 
will  not  only  facilitate  the  application  of  the  sanitary  treatment,  whenever  it  may 
be  necessary  to  do  so,  but  also  because  when  the  disinfection  of  the  clothes  and 
baggage  shall  be  made  on  land,  it  will  not  be  necessary  to  transfer  the  passen- 
gers to  the  lazaretto,  and  thus  cause  them  an  unnecessary  delay  in  landing. 

On  the  other  hand,  when  the  construction  of  said  building  is  completed,  the 
maritime  sanitary  officers  will  reside  in  a  place  more  suitable  for  the  fulfilment 
of  their  duties. 


